Surgical Management of Massive Metal Bezoar

This is a successful removal of more than 450 pieces of metal objects from a patient's stomach: a case report

BACKGROUND

Ingestion of foreign bodies may be seen unconsciously or intentionally in patients with mental health problems. Most cases pass through the esophagus slowly; however, in some cases, the tumor may be located in narrower areas of the digestive tract that require endoscopic or surgical intervention. This study describes a rare case of successful removal of more than 450 pieces of metal objects from the stomach of a 36-year-old man via ingestion of foreign bodies at Imam Khomeini Hospital in Ahvaz.

CASE PRESENTATION

A 36-year-old male patient (Aryan race) presented with complaints of chronic abdominal pain, frequent vomiting, and intolerance to liquids and food. The patient's companions mentioned a history of gradual ingestion of small metal objects 3 months prior. The patient was conscious and had stable vital signs. In the patient's X-ray and endoscopy, multiple metal objects inside the patient's stomach were observed, causing gastric outlet obstruction. The patient underwent gastrostomy surgery, and 452 screws, nuts, keys, stones, and other metal parts weighing 2900 g were removed from the stomach. Five days after the operation, the patient was transferred to the psychiatric service in good general condition and was diagnosed with psychosis, and her condition returned to normal at follow-up.

CONCLUSION

Successful removal of this foreign body is rare. In chronic abdominal pain, especially in the context of psychiatric disorders, attention should be given to the ingestion of foreign bodies. In swallowing large amounts of sharp and metallic foreign objects, surgical intervention is necessary, especially in cases of obstruction, and saves the patient's life.

Removing 216 sharp metal foreign objects from the digestive tract of a 30-year-old male: case report

Introduction and importance

Foreign body (FB) ingestion and its complications are abundant in emergency departments. This potentially severe problem had a peak incidence in children aged 6 months to 6 years. Intentional adult cases are voluntary and more common in prisoners and people with psychiatric problems. However, most patients (90%) remain asymptomatic, and these pass through the body spontaneously.

Case presentation

The authors report a case of surgically removing plenteous sharp-pointed metallic foreign bodies ingested by a young male deaf-mute bipolar schizoaffective patient from his stomach, intestine, and rectum. Furthermore, the authors have reviewed the available literature for similar cases.

Clinical discussion

Less than 1% of patients need surgical removal, 10-20% need to be taken out endoscopically, and the remaining pass spontaneously. Plain radiography is the most available imaging modality detecting the number, material, and estimated place of the alimentary canal trapped.

Conclusion

For the risk of perforation, migration, and peritonitis, surgery is indicated in such situations.