A 69 y.o. woman is brought to the ED. Her chief complaint is " the refrigerator was talking to me"

She appears to have sustained some trauma

The pt began a stroke evaluation and physicians reviewed her old chart. The old chart reveals she was admitted for benzo withdrawal seven months prior. At that time she had a CT showing a ventral hernia with a chicken bone in it. This was not reported to service caring for her; except in an overread.

Chicken bone in a ventral hernia,.

the patient is delerious and can give no history. . The pan scan showed an L 1 compression fracture, a vertebral artery occlusion, open nasal fracture, and a chicken bone in the rectum. What needs to be done?

Our patient had a foreign body which had been in the GI tract for almost seven months.  This is unusual since the average transit time of the gut is usually 30-40 hours.  Part of the explanation probably lies in the fact that it stayed in the ventral hernia for some time.

Magnetic beads causing a bowel obstruction

Foreign bodies in the gut have a spontaneous passage rate of 64% and the general rule is that if the foreign body is past the duodenal curve is should be simply allowed to continue. Most foreign body ingestions are in children ages six months to three years.  In large studies 10-20% are removed endoscopically (esophageal are predominant or sharp objects in the stomach).  Only 1% of foreign bodies require surgery.  Perforation due to a sharp object or bowel obstruction from ingested magnets are the major reasons for surgery. Multiple foreign bodies are sometimes found in psychiatric patients.

Our patient recovered from her benzo withdrawal. The facial fractures , rib fractures and spine fractures were non operative,and the chicken bone was left to pass on its own. She was given an ASA for the vertebral occlusion and discharged.

Another population other than children which swallow foreign bodies are psychiatric patients.

MacGregor D, Ferguson J. Foreign body ingestion in children: an audit of transit time. 1998 Nov;15(6):371-73.

Yeh H, Chao H, Chen S, et al. Analysis of radiopaque foreign body expelled by spontaneous passage in children A 15 year single-center study.

Gitlin D, Caplon J, Rogers M. et al. Foreign body ingestion in patients with personality disorders. Psychosomatics. 2007;22:275-78.

Li Y Multiple magnetic beads cause intestinal obstruction. Journal of Pediatrics. July 2020 vol 71(1)pe 53.