A woman in her 30s with a history of psychiatric care required a colonoscopy after intentionally swallowing multiple nails, according to a recent case report. She presented with persistent abdominal pain, marking her sixth episode of foreign body ingestion in a year.
The nails became lodged in the ileocecal valve, between the small and large intestines. Bhoowit Lerttiendamrong, MD, from the University of Connecticut School of Medicine, described the case to MedPage Today. Repeat imaging tracked the nails’ movement from the mid-abdomen to the right lower quadrant, ultimately clustering near the valve.
A Rare Procedure
The medical team used a cap-assisted colonoscopy to remove the nails. This technique involves attaching a hard, transparent cap to the end of the scope to protect the mucosal lining. A short polymer tube minimizes blind spots, prevents mucosal injuries, and aids in lesion size assessment.
Lerttiendamrong and colleagues reported in BMJ Case Reports that the nails were successfully removed with minimal trauma to the colon. This case highlights the effectiveness of the cap in reducing injury during sharp foreign body removal, particularly in the lower gastrointestinal tract.
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Understanding Foreign Body Ingestion
In most cases, 80% of ingested foreign bodies pass spontaneously. However, endoscopic retrieval is recommended for patients who don’t respond to conservative management or when sharp objects pose a perforation risk. Nails, due to their sharp, irregular shapes, often require surgical intervention.
She was initially managed conservatively, with serial abdominal radiographs every 12 hours, bowel rest, and 3 liters of polyethylene glycol therapy. After 4 days with no spontaneous passage, the nails were removed using cap-assisted colonoscopy.
All eight nails were successfully removed using a snare, with care taken to secure the sharp ends beneath the cap. Inspection of the mucosa after the procedure showed only minor superficial abrasions.
Successful Removal and Follow-Up
The psychiatry department was consulted, but the patient refused admission despite recommendations. One year later, she remains under outpatient care with no further complications reported.
