Gastrointestinal 'crosses'. A new shade from an old palette

Abstract

Background: We present our experience with an as yet undescribed type of intentionally ingested metallic foreign body that was specially designed to arrest in its passage and cause perforation of the gastrointestinal tract. The two halves of a standard paper clip are tied crosswise with a rubber band, forming an elastic "cross." With its branches squeezed to lie parallel, the cross is wrapped into a small strip of paper and ingested. After being released from its wrapper, the branches of the cross spring back to their original position and cause perforation of the bowel wall.

Design: Case series.

Setting: University hospital, Bulgaria.

Patients: Five male prisoners from the same jail undergoing laparotomy for foreign body removal during 1 week in January 1994.

Interventions: Laparotomy, removal of the foreign bodies through incisions of the bowel wall, immediate restoration of the gastrointestinal tract continuity, and peritoneal lavage and drainage.

Outcome measures: Morbidity and mortality.

Results: Two of the patients were initially observed but subsequently underwent surgery for perforations of the gastrointestinal tract. Three of the patients underwent immediate operative treatment. There were 20 total crosses ingested; all foreign objects impacted and perforated the stomach (50%), first duodenal portion (25%), and fourth duodenal portion (20%). There was no morbidity or mortality among the five patients treated.

Conclusions: Because ingested crosses that have been released from their wrappers never move distally, the only definitive solution is to operate early.