Endoscopic management of a nail-magnet aggregation impacted in the terminal ileum: a case report

Abstract

Management of inedible foreign objects within the gastrointestinal tract requires diligent observation and timely intervention in situations of impaction, obstruction or perforation. Here, we describe an adult patient with borderline personality disorder presenting with sequential ingestions of nails and magnets that had already passed beyond the reach of upper endoscopy. These objects conglomerated as a single mass in the terminal ileum and failed to clear into the colon despite a prolonged trial of conservative management. The patient underwent a successful colonoscopy to remove a significant component of the bezoar, allowing the remaining objects to pass through the ileocecal valve and be eliminated. This case highlights the benefits of careful conservative management with prudent use of endoscopy to manage impaction of foreign bodies in the terminal ileum in an otherwise stable adult patient.

Figure 1

Radiographic series of sequentially ingested nails and magnets. The nails measured 2 cm long and magnets 2 cm in diameter and 0.75 cm in height. All dates are relative to initial ingestion of nails. (A) Day 1 – Nails in small bowel. (B) Day 6 – Additional ingestion of nails and a magnet. Original nails from A are clustered in right lower quadrant. (C) Day 9 – An additional four magnets have migrated to the right lower quadrant collection. (D) Day 15 – Coronal computer tomography (CT) view of nail-magnet collection in terminal ileum. (E) Day 15 – Axial CT view of nail-magnet collection in terminal ileum. (F) Day 26 – Smaller nail-magnet collection in transverse colon, 4 days after colonoscopic removal of the bulk of the collection.

Figure 2

Endoscopic photographs of removal of nail-magnet collection from the terminal ileum. (A) Endoscopic forceps used to remove nails visible from the ileocecal valve (left of photograph). (B) Use of an endoscopic snare to remove additional nails from the ileocecal valve. (C) Collection of nails in cecum after their removal from the ileocecal valve. (D) Removal of the retrieved nails using a Roth Net® retrieval basket on colonoscopy withdrawal.