The following article is brought to you by Margaret A. Oppenheimer, author of Beat Crohn's! Getting to Remission with Enteral Nutrition. Check out her blog posts to learn about the latest research on Crohn's disease.

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From Cockroaches to Cake Ornaments:

Hidden Treasures From the Human Digestive Tract

©2011 Margaret A. Oppenheimer. Tell me what you eat, and I will tell you who you are, said the noted epicure Jean Anthelme Brillat-Savarin. After reading about some of the weird and wonderful objects found in the human digestive tract, I hope he's wrong, or we'd be calling our neighbors anything from cockroaches to cake ornaments. Join me in discovering some of the most unusual items retrieved from the human stomach and intestines.

See It , Eat It

As you might expect, children are particularly apt to swallow found objects. Coins are overwhelmingly the objects of choice, although there are cultural variations.¹ Fish bones, for example, are frequently retrieved in Japanese and Chinese children, whereas turban pins show up in youngsters in Turkey.² Some kids, though, find more unlikely eating matter. A three-year-old who consumed three industrial magnets ended up hospitalized for a month. The magnets, landing in different loops of bowel and pulled together by magnetic attraction, perforated the intestines in six places.³ Ouch!

Swallow First, Regret Later

Then there are the incautious eaters. Two or three days after enjoying a slice of Christmas cake, an elderly woman was in the emergency room with a bowel perforation. Found in the small intestine: one small, plastic robin, a cake decoration. Its beak had perforated the ileum.⁴ She might want to compare notes with an elderly Japanese man who consumed a soft-shelled turtle during a New Year's festival. The turtle's foot was discovered two months later when the man presented with a bowel perforation.⁵

Did You Chew?

Seniors are often represented among consumers of foreign objects due to difficulties in chewing or swallowing. But plenty of younger adults are simply careless, such as a 31-year-old who admitted he wasn't good about chewing his food. Two days after gulping down chicken, he was in so much pain he couldn't sit down. He turned out to have a chicken bone lodged in the anal canal.⁶

A lamb bone in the same location in yet another careless chewer created a perianal abscess.⁷ Chew your food, gentlemen!

Some diners would benefit from paying more attention to the appearance of the food on their plate. A hunter who routinely ate the game he bagged presented with blood in his stool, leading to the discovery of five shotgun pellets in his transverse colon. A "polyp retrieval net" (um...is that anything like a butterfly net?) was used to scoop up the buckshot.⁸

Dental Dilemmas

Dental appliances go astray with surprising frequency. A prosthetic post and crown lodged in the appendix of a 77-year-old woman. Commenting on the report of its retrieval, Dr. Lawrence J. Brandt asked dryly, "Do we use the same billing codes as our dental colleagues for extraction of an impacted tooth?"⁹ Given the staggering cost of a post and crown, I would be inclined to wash off the item and ask the dentist to put it back in.

A gentleman who swallowed his dental bridgework did exactly that after the object navigated the GI tract with aplomb and exited in the usual fashion.¹⁰

Then there was the toothbrush that made it all the way to the colon. The authors inform us, "Toothbrush swallowing is a rare event." I should hope so! It turns out many toothbrush swallowers have eating disorders; they lose hold of toothbrushes used to induce vomiting.¹¹

Speaking of personal grooming, a pocket comb was found in the stomach of a 65-year-old man who disclaimed any memory of when or how he might have swallowed it.¹² After raising too many glasses, perhaps?

Were You Drinking?

Heavy drinkers may end up with more than alcohol inside. A drinking game called "Quarters" involves dropping a 25-cent piece into a mug of beer. The contestant is challenged to drink successive mugfuls, each time capturing the coin at the bottom with the teeth. Several students have ended up in the ER for coin retrieval after an unwary swallow.¹³

A more exotic finding was the cocktail stick poking through the by-then infected duodenum of a 19-year-old, three months after he swallowed it during New Year's festivities.¹⁴ However, even he was outdone by a young British man who swallowed two teaspoons while intoxicated. Although one passed naturally after twelve months, the other stuck to the wall of the ascending colon, from whence it had to be extracted surgically ten years later.¹⁵

Another spoon swallower, this time female, initially had a fish bone stuck in her throat. She tried to dislodge it with her coffee teaspoon, and inadvertently swallowed the spoon.¹⁶

Of Unsound Mind

Mental illness, sadly, is a major cause of the ingestion of foreign objects by adults. A case in point was a prisoner with schizophrenia who had a long history of consuming nonfood objects. On one particularly dramatic occasion, his duodenum (the first part of the small intestine) housed four plastic teaspoons and a ballpoint pen.¹⁷

A more diverse collection of objects was retrieved from the stomach of a woman with multiple conditions causing mental impairment. The loot included two towels, an elastic hair band, a blue bottle cap, and a plastic sheet. She had already vomited up a paper towel.¹⁸

After considering that case, the cockroach found in the transverse colon of a woman with schizophrenia hardly seems worthy of note. She may have swallowed it during her colonoscopy prep, together with the green Jell-O she was eating.¹⁹

With Criminal Intent

The ingestion or secretion of foreign objects for personal gain offers yet another category of intestinal ephemera. In a so-far unique case, a prisoner hid a handcuff key in his rectum before undergoing orthopedic surgery. Unfortunately for his escape plans, the key was discovered when rectal anesthesia was administered during surgery.²⁰

Doctors are more familiar with traveling drug smugglers who may swallow their product for personal "delivery" on arrival. Sometimes, however, there's a kink in the plan. After eight days of laxatives produced no results, 83 packets of cocaine were surgically removed from the stomach of a smuggler who was newly arrived in London.²¹

The Moral

Readers, your mother was right. Slow down, chew your food, and watch what you eat. The gastrointestinal system is a beautifully designed collection of pipes and tubes. Treat it right and don't clog your plumbing!

This article is brought to you by Margaret A. Oppenheimer, author of Beat Crohn's! Getting to Remission with Enteral Nutrition, the book about the only clinically tested dietary treatment for Crohn's disease. Visit her Crohn's News Blog to read about the latest research on Crohn's disease..

Notes

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2. Saz EU, Arikan C, Ozgenç F, Duyu M, Ozananar Y. The utility of handheld metal detector in confirming metallic foreign body ingestion in the pediatric emergency department. Turk J Gastroenterol. 2010 Jun;21(2):135-9.
3. Kircher MF, Milla S, Callahan MJ. Ingestion of magnetic foreign bodies causing multiple bowel perforations. Pediatr Radiol. 2007 Sep;37(9):933-6. Epub 2007 Jul 11.
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5. Editor's quiz: GI snapshot. Gut 2004;53:1158.
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13. Gluck M. Coin ingestion complicating a tavern game. West J Med. 1989 Mar;150(3):343-4.
14. Gransden WR, Eykyn S. Cocktail stick injuries. Br Med J (Clin Res Ed). 1988 Jan 30;296(6618):359.
15. Deeba S, Purkayastha S, Jeyarajah S, Darzi A. Surgical removal of a tea spoon from the ascending colon, ten years after ingestion: a case report. Cases J. 2009 Sep 9;2:7532.
16. Song Y, Guo H, Wu JY. Travel of a mis-swallowed long spoon to the jejunum. World J Gastroenterol. 2009 Oct 21;15(39):4984-5.
17. Islam SR, Islam EA, Hodges D, Nugent K, Parupudi S. Endoscopic removal of multiple duodenum foreign bodies: An unusual occurrence. World J Gastrointest Endosc. 2010 May 16;2(5):186-9.
18. Martindale JL, Bunker CJ, Noble VE. Ingested foreign bodies in a patient with pica. Gastroenterol Hepatol (N Y). 2010 Sep;6(9):582-4.
19. Malik TA, Luz LP, Peter S. Caught on camera: an unusual type of bug in the gut. Gastrointest Endosc. 2010 Sep 18. [Epub ahead of print]
20. Parlow JL. An unexpected benefit of pre-emptive rectal analgesic administration: the "key" to postoperative analgesia. CMAJ. 2000 Dec 12;163(12):1576-7.
21. Swan MC, Byrom R, Nicolaou M, Paes T. Cocaine by internal mail: two surgical cases. J R Soc Med. 2003 Apr;96(4):188-9.

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