Patients saved from colectomy in exchange for two dimes. Foreign body ingestion is a common indication for GI consultation. It is quite common in the pediatric population. In the adult population, risk factors for foreign body ingestion include psychiatric conditions, incarceration, and alcohol abuse. In general, the majority of objects that make it to the distal GI tract will spontaneously pass without any complications. Round and blunt objects, like coins, are more likely to spontaneously pass in comparison with sharp or long objects, which are more likely to be retained. Rarely, however, even blunt objects, if retained, can erode through the bowel wall and lead to perforation, obstruction, or bleeding, which might require abdominal surgery. Serial radiographs are done to document progression along the GI tract and to ensure passage. Serial abdominal exams are done to ensure the abdomen remains soft and to allow for timely intervention if acute abdomen develops. Bowel care is also used to help expel the object. If despite these measures, the object is not passed, or if a perforation arises, surgery is required. Guidance regarding the role and timing of colonoscopy for colonic retained foreign bodies is not clear. Here, we present a case of retained colonic foreign body complicated by a contained perforation that was managed endoscopically by object retrieval and defect closure. A 37-year-old male with a history of schizoaffective disorder and repeated foreign body ingestions requiring multiple abdominal surgeries and small bowel resections presented with reported ingestion of coins and pebbles. Daily KUBs showed retained coins and pebbles in the colon. Initial colonoscopy was done, during which three coins and a few pebbles were removed. Post-colonoscopy, KUB highlighted that an additional coin had remained in the cecum. Despite aggressive daily bowel care, serial KUBs showed the coin did not move. CT scan was further obtained, which confirmed a metal object retained in the cecum with associated pericecal inflammatory changes, raising concerns for a contained perforation. Clinically, the patient remained asymptomatic. Surgery was consulted, but they were hesitant to proceed with surgery, given his surgical history and concerns for a hostile abdomen, and instead recommended attempted endoscopic retrieval. Pre-repeat colonoscopy, KUB highlighted the coin remained in the cecum. Colonoscopy was done with fluoroscopic guidance to help better localize the coin. Eventually, and after copious irrigation, a partially embedded coin within the wall of the cecum was seen through a small defect in the cecal wall. After a gentle manipulation of the coin with a rat tooth forceps, Frank Buss was noted. The general surgical team was called into the room, and the case was discussed. Decision was made to proceed with endoscopic retrieval and defect closure. Rat tooth forceps was used to carefully retrieve the coin into the colonic lumen. After successful retrieval of the coin, by using fluoroscopy, it was noted that there was a second retained coin within the same defect area. The second coin was carefully retrieved using the same technique and subsequently both coins were removed using a Rothnet. Over the scope clip was attached onto the colonoscope, which was then carefully re-advanced into the SECAM. The defect area was closely investigated and copiously irrigated. Next, the clip was successfully deployed and the defect was closed. Post-procedural CAT scan was done, and it confirmed no free air in the abdomen. Post-procedurally, the patient was treated with antibiotics empirically, and the patient remained asymptomatic. This case highlights that small foreign bodies that reach the colon do not always spontaneously pass and can potentially erode through the wall and progress to perforation. Close follow-up to ensure passage with serial imaging and abdominal exams is critical. An attempt to avoid surgical interventions, endoscopic retrieval, and defect closure is safe and can be considered.

foreign body ingestion

children

risk factors

GI tract complications

endoscopic retrieval