Clinical CommunicationsA penny for your thoughts: Small bowel obstruction secondary to coin ingestion
Introduction
Small bowel obstruction is an important cause of abdominal pain in Emergency Department (ED) patients. Common causes include postoperative intra-abdominal adhesions, hernias, and occasionally neoplasms. Less commonly, foreign body ingestions have been reported as the etiology of obstruction. In recent years, there have been reports of small bowel obstruction due to organic material such as fruit pits and crustacean shells, and inorganic material such as dental molds, vascular grafts and postoperative hardware (1, 2, 3, 4, 5, 6).
Section snippets
Case report
The patient was a 22-year-old woman presenting with a 3-week history of worsening abdominal pain. She described the pain as sharp, intermittent, located in the right lower quadrant with no alleviating or exacerbating factors, and associated with intermittent vomiting. During this time, she described a 10-pound weight loss. She had normal bowel movements and flatus, with the last bowel movement being 6 h before arrival. Approximately 1 week before presentation she was seen in another hospital ED
Hospital course
At operation, the terminal ileum was found to be grossly fibrotic with a bowel wall thickness of 3.0 cm. There was a large stricture at the ileocecal valve where a partial perforation due to a rusted copper penny was found. Resection of 25 cm of the distal ileum was done. There was no indication of prior ileocecal valve stricture (see Figure 2).
Discussion
Small bowel obstruction is a common problem encountered in the evaluation of ED patients who present with significant abdominal pain, nausea and vomiting. As many as 20% of patients admitted to a surgical service for acute abdominal pain are found to have bowel obstruction (7). Obstruction may be mechanical or due to adynamic ileus. Approximately 50% of mechanical obstructions are due to postoperative intra-abdominal adhesions, with hernias, neoplasms, and inflammatory processes or strictures
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Cited by (8)
Predictive factors associated with spontaneous passage of coins: A ten-year analysis of paediatric coin ingestion in Australia
2018, International Journal of Pediatric OtorhinolaryngologyCitation Excerpt :Coins are the most commonly ingested foreign body among paediatric populations [1,2]. Although most ingested coins are either passed spontaneously or retrieved with medical intervention, without serious consequence, there is potential for serious morbidity and mortality to occur if the coins remain in the gastrointestinal tract [3–7]. Complications can include stricture formation, oesophageal perforation, tracheo-oesophageal fistula and aorto-oesophageal fistula [8].
A systematic review of paediatric foreign body ingestion: Presentation, complications, and management
2013, International Journal of Pediatric OtorhinolaryngologyCitation Excerpt :In fewer than 10% of cases, foreign bodies may impact within the intestines [15]. Foreign body impaction may result in complications such as mucosal abrasions within the gastrointestinal tract, bleeding, gastric outlet obstruction, oesophageal or gastrointestinal perforation and secondary mediastinitis, peritonitis, abscess or fistula formation [16–19]. Therefore, impaction is generally a strong indication for foreign body removal.
Numismedica: Health problems caused by coins
2009, American Journal of the Medical SciencesCitation Excerpt :A schizophrenic man who ingested multiple coins developed a sigmoid volvulus due to a coin bezoar.11 Swallowed coins can vary from being asymptomatic to producing symptoms such as failure to drink, pain, and obstruction.9,12–16 One review of 592 cases of esophageal coins found 24% to be asymptomatic.13
Massive Penny Ingestion: The Loot with Local and Systemic Effects
2008, Journal of Emergency MedicineCitation Excerpt :This may give a false impression of the coins being in the colon, just as in our case (6,7). Coins may become impacted at sites of gastrointestinal tract narrowing like the proximal or distal esophagus and terminal ileum, leading to perforation or the development of an inflammatory mass, leading to bowel obstruction (6,12–14). After absorption, zinc concentrates in the liver, pancreas, and kidney as well as erythrocytes, hippocampus, cerebellum, prostate and bone, and is excreted primarily via bile and pancreatic juice into the feces (5,19).
Keeping an eye out for bowel obstruction
2006, Pediatric Emergency CareRare case of foreign body in the digestive tract
2006, Proktologia