Animal, Vegetable, or Mineral: A Collection of Abdominal and Alimentary Foreign Bodies

and

Disclosures

Appl Radiol. 2000;29(11) 

In This Article

Ingested Foreign Bodies

An appropriate history is usually available, which will give a key to the type of foreign body expected, as well as to the expected site of obstruction or other symptoms. Bolus impaction in adults is usually caused by animal or fish bones or by unchewed boluses of meat[3] (figure 1). Occasionally, however, such history is not available (especially in children, mentally incompetent, or uncooperative patients) and 20% of patients may be asymptomatic[4,5] (figure 2). Indeed, when one foreign body is known to have been ingested, consideration should be given to the possibility of a second.[2,6] Children usually impact with ingested and sometimes unwitnessed coins, toys, or other foreign objects.[3]

Figure 1.

Pharyngeal bolus impactions. (A) Vallecular fish bone. This 68-year-old man felt something caught in his throat while eating a meal of snapper. Lateral soft-tissue view of the neck shows the offending fish bone (arrow) lodged in the vallecula above the epiglottis and illustrates the value of phonating "Eee" to distend the pharynx. (B) Hypopharyngeal chicken bone stuck in the throat of a 61-year-old man. Lateral view of the neck shows the impacted fragment of bone (arrows) at the C6/C7 level and shows the value of recognizing the normal range of pharyngeal cartilage calcification. The offending foreign body is recognized as an additional nonanatomical calcified density. (C) Oyster impacted in the hypopharynx of a 44-year-old woman. Lateral view of the neck shows widening of the preverebral space (mass effect) with mottled gas pattern (abnormal lucency) due to the foreign body. (D) Hypopharyngeal fish bolus in a 90-year-old woman with dysphagia following an overzealous meal of fish. Lateral view of the neck shows the impacted fish bolus at the C5/C6 level. This case combines all the signs of an impacted pharyngeal foreign body, with a 2-cm soft tissue mass effect bowing forward the adjacent posterior tracheal contour, bubbly lucency, and specks of calcification.

Figure 1.

Pharyngeal bolus impactions. (A) Vallecular fish bone. This 68-year-old man felt something caught in his throat while eating a meal of snapper. Lateral soft-tissue view of the neck shows the offending fish bone (arrow) lodged in the vallecula above the epiglottis and illustrates the value of phonating "Eee" to distend the pharynx. (B) Hypopharyngeal chicken bone stuck in the throat of a 61-year-old man. Lateral view of the neck shows the impacted fragment of bone (arrows) at the C6/C7 level and shows the value of recognizing the normal range of pharyngeal cartilage calcification. The offending foreign body is recognized as an additional nonanatomical calcified density. (C) Oyster impacted in the hypopharynx of a 44-year-old woman. Lateral view of the neck shows widening of the preverebral space (mass effect) with mottled gas pattern (abnormal lucency) due to the foreign body. (D) Hypopharyngeal fish bolus in a 90-year-old woman with dysphagia following an overzealous meal of fish. Lateral view of the neck shows the impacted fish bolus at the C5/C6 level. This case combines all the signs of an impacted pharyngeal foreign body, with a 2-cm soft tissue mass effect bowing forward the adjacent posterior tracheal contour, bubbly lucency, and specks of calcification.

Figure 1.

Pharyngeal bolus impactions. (A) Vallecular fish bone. This 68-year-old man felt something caught in his throat while eating a meal of snapper. Lateral soft-tissue view of the neck shows the offending fish bone (arrow) lodged in the vallecula above the epiglottis and illustrates the value of phonating "Eee" to distend the pharynx. (B) Hypopharyngeal chicken bone stuck in the throat of a 61-year-old man. Lateral view of the neck shows the impacted fragment of bone (arrows) at the C6/C7 level and shows the value of recognizing the normal range of pharyngeal cartilage calcification. The offending foreign body is recognized as an additional nonanatomical calcified density. (C) Oyster impacted in the hypopharynx of a 44-year-old woman. Lateral view of the neck shows widening of the preverebral space (mass effect) with mottled gas pattern (abnormal lucency) due to the foreign body. (D) Hypopharyngeal fish bolus in a 90-year-old woman with dysphagia following an overzealous meal of fish. Lateral view of the neck shows the impacted fish bolus at the C5/C6 level. This case combines all the signs of an impacted pharyngeal foreign body, with a 2-cm soft tissue mass effect bowing forward the adjacent posterior tracheal contour, bubbly lucency, and specks of calcification.

Figure 1.

Pharyngeal bolus impactions. (A) Vallecular fish bone. This 68-year-old man felt something caught in his throat while eating a meal of snapper. Lateral soft-tissue view of the neck shows the offending fish bone (arrow) lodged in the vallecula above the epiglottis and illustrates the value of phonating "Eee" to distend the pharynx. (B) Hypopharyngeal chicken bone stuck in the throat of a 61-year-old man. Lateral view of the neck shows the impacted fragment of bone (arrows) at the C6/C7 level and shows the value of recognizing the normal range of pharyngeal cartilage calcification. The offending foreign body is recognized as an additional nonanatomical calcified density. (C) Oyster impacted in the hypopharynx of a 44-year-old woman. Lateral view of the neck shows widening of the preverebral space (mass effect) with mottled gas pattern (abnormal lucency) due to the foreign body. (D) Hypopharyngeal fish bolus in a 90-year-old woman with dysphagia following an overzealous meal of fish. Lateral view of the neck shows the impacted fish bolus at the C5/C6 level. This case combines all the signs of an impacted pharyngeal foreign body, with a 2-cm soft tissue mass effect bowing forward the adjacent posterior tracheal contour, bubbly lucency, and specks of calcification.

Figure 2.

Esophageal opaque bolus impaction (bottle cap, circled) in an 18-year-old man with dysphagia who presented the day after a session of drinking at the bar. A twist-top bottlecap is seen lodged in the mid-esophagus. This case illustrates the coronal anatomical orientation of the esophageal lumen with consequent similar orientation of flat impacted foreign bodies. Tracheal foreign bodies usually orientate sagittally. This case also illustrates the danger of the practice of opening such bottles with the teeth, especially when inebriated.

A foreign body may become impacted in the pharynx, which in turn may cause choking or gagging because it is large or associated laryngeal spasm.[4] Conversely, a foreign body impacted in the esophagus may be regurgitated back into the pharynx with similar risk of airway compromise.[2,6] A crash cart for cardiopulmonary resuscitation must be immediately available during assessment of these patients.

Approximately 70% to 80% of ingested impacted foreign bodies will lodge in the pharynx or cervical esophagus.[4,6,7,8] This is particularly likely to occur with sharp objects such as fish bones[3] (figure 3A). When this is the suspected location of impaction, the most useful initial study is a lateral soft-tissue view of the neck.[3] It should be centered below the angle of the mandible with the patient seated upright, neck extended, shoulders low and posterior. The patient phonating "Eeee" may prove useful to distend the pharynx and improve visibility.[8] Regardless of optimal technique, it may be difficult to differentiate small bone fragments from laryngeal cartilage calcifications. A reference guide to the range of such calcifications is of value in exploring this problem.[9]

Figure 3.

Esophageal nonopaque bolus impaction. (A) Fishbone in a 58-year-old man with acute suprasternal odynophagia and sensation of a retained foreign body after a fish meal. Barium swallow shows a 2-cm long linear foreign body (arrow) embedded in the esophagus just below its upper sphincter. (B) Meat bolus impaction in a 29-year-old man with recurrent episodes of food impaction. Barium swallow shows a bolus of meat (chicken) held up in the mid esophagus. Subsequent work-up revealed a stricture at the corresponding location of the esophagus.

Figure 3.

Esophageal nonopaque bolus impaction. (A) Fishbone in a 58-year-old man with acute suprasternal odynophagia and sensation of a retained foreign body after a fish meal. Barium swallow shows a 2-cm long linear foreign body (arrow) embedded in the esophagus just below its upper sphincter. (B) Meat bolus impaction in a 29-year-old man with recurrent episodes of food impaction. Barium swallow shows a bolus of meat (chicken) held up in the mid esophagus. Subsequent work-up revealed a stricture at the corresponding location of the esophagus.

In the esophagus, favored sites of hold-up include the level of the aortic arch, the left main bronchus, and the gastroesophageal junction, especially when there is a pre-existing stricture[3,4] (figure 3B). A barium swallow may be required to find these obstructed foreign bodies and is also warranted for follow-up after the acute impaction is resolved to detect an underlying stricture that is usually present.[2,3] A foreign body impacted in the pharynx or esophagus is unlikely to pass spontaneously, and warrants immediate removal.[2,4] Once in the abdomen, the foreign body may stop at the gastric pylorus (usually if it is thicker than 2.0 cm and longer than 5.0 cm), fail to traverse the duodenal sweep (usually if it is long, >10 cm), or obstruct at the ileocecal valve.[2] Again, a pre-existing stricture may make passage of the body difficult (figure 4).

Figure 4.

Gastric ingested foreign bodies. (A) A battery in the stomach of a 23-year-old man, frequent attendee of the emergency room. Abdominal radiograph shows a AA dry-cell battery in the stomach. (B) Toothbrushes (arrow) in the stomach of a 40-year-old mentally ill man who has tried to swallow a variety of objects. On this occasion, these abdominal films obtained after a Gastrografin swallow shows two gastric toothbrushes, rendered visible due to the contrast trapped in the base of the bristles and the rough textured part of the handle. (C) Gastric bezoar in a 82-year-old man with Bilroth 1 resection 30 years ago for peptic ulcer, who now has a long history of epigastric discomfort after meals. Barium study shows slight narrowing at the gastro-duodenal anastomosis. There is a large gastric bezoar. Occasionally, a fragment of the bezoar impacts in the anastomosis precipitating the acute obstructive symptoms.

Figure 4.

Gastric ingested foreign bodies. (A) A battery in the stomach of a 23-year-old man, frequent attendee of the emergency room. Abdominal radiograph shows a AA dry-cell battery in the stomach. (B) Toothbrushes (arrow) in the stomach of a 40-year-old mentally ill man who has tried to swallow a variety of objects. On this occasion, these abdominal films obtained after a Gastrografin swallow shows two gastric toothbrushes, rendered visible due to the contrast trapped in the base of the bristles and the rough textured part of the handle. (C) Gastric bezoar in a 82-year-old man with Bilroth 1 resection 30 years ago for peptic ulcer, who now has a long history of epigastric discomfort after meals. Barium study shows slight narrowing at the gastro-duodenal anastomosis. There is a large gastric bezoar. Occasionally, a fragment of the bezoar impacts in the anastomosis precipitating the acute obstructive symptoms.

Figure 4.

Gastric ingested foreign bodies. (A) A battery in the stomach of a 23-year-old man, frequent attendee of the emergency room. Abdominal radiograph shows a AA dry-cell battery in the stomach. (B) Toothbrushes (arrow) in the stomach of a 40-year-old mentally ill man who has tried to swallow a variety of objects. On this occasion, these abdominal films obtained after a Gastrografin swallow shows two gastric toothbrushes, rendered visible due to the contrast trapped in the base of the bristles and the rough textured part of the handle. (C) Gastric bezoar in a 82-year-old man with Bilroth 1 resection 30 years ago for peptic ulcer, who now has a long history of epigastric discomfort after meals. Barium study shows slight narrowing at the gastro-duodenal anastomosis. There is a large gastric bezoar. Occasionally, a fragment of the bezoar impacts in the anastomosis precipitating the acute obstructive symptoms.

The nature of the offending foreign body is important to its detection and management. Metal or bony material are easily seen. Similarly, lead-containing glass or crystal may be visible. Plastic or wood is almost always a challenge unless there is some adherent lead paint. Fish bones are usually a problem, as they are often sharp and cause considerable irritation, and are variably opaque. Other sharp and pointed objects (e.g., other meat bones, toothpicks, razors, and pins) are at risk of perforating the gut[1,10] (figure 5). Sometimes, the penetrating object may seal the perforation and prevent leakage of bowel content until it is removed.[8] Ideally, such objects should be removed while still in the stomach.[2]

Figure 5.

Sharp ingested foreign bodies. (A) A pin (arrow) in the appendix of a 74-year-old woman with subacute right lower quadrant pain. A series of abdominal radiographs over several days showed no change in the position of this pin in the right lower quadrant. She had forgotten swallowing the pin, a hazard of the practice of holding pins between her lips when sewing. At eventual laparotomy, it was discovered that the pin had become caught in the appendix, where it had initiated chronic appendicitis. (B) A rectal toothpick in a 61-year-old man with hematochezia. Barium enema shows a linear filling defect in the rectal wall. This proved to be a toothpick that had been inadvertently swallowed some time ago. It had migrated through almost the entire length of the intestinal tract, but had become lodged in the rectal wall. This case illustrates a hazard of the habit of chewing toothpicks, as well as the potential for small sharp objects to cause direct penetrating injury to the bowel wall.

Figure 5.

Sharp ingested foreign bodies. (A) A pin (arrow) in the appendix of a 74-year-old woman with subacute right lower quadrant pain. A series of abdominal radiographs over several days showed no change in the position of this pin in the right lower quadrant. She had forgotten swallowing the pin, a hazard of the practice of holding pins between her lips when sewing. At eventual laparotomy, it was discovered that the pin had become caught in the appendix, where it had initiated chronic appendicitis. (B) A rectal toothpick in a 61-year-old man with hematochezia. Barium enema shows a linear filling defect in the rectal wall. This proved to be a toothpick that had been inadvertently swallowed some time ago. It had migrated through almost the entire length of the intestinal tract, but had become lodged in the rectal wall. This case illustrates a hazard of the habit of chewing toothpicks, as well as the potential for small sharp objects to cause direct penetrating injury to the bowel wall.

Metallic ingested foreign bodies require special consideration in their management. The acid of the stomach may react chemically with the metal and result in mucosal inflammation, ulceration, and perforation. Similarly, gastric acid may break the seal of an ingested battery, leading to corrosive toxicity. This is of particular concern with miniature alkaline batteries. These batteries are in common use in electronic devices and toys and are small and easily swallowed. Break down of the swallowed battery allows discharge of its contents. They may contain strong concentration (40% to 45%) sodium or potassium hydroxide, which has been reported to be responsible for perforation by alkali necrosis of the esophagus, stomach, and small bowel Meckel's diverticulum with serious or fatal consequence.[6,11,12,13] The chemical toxicity of heavy metals that may be contained within some of these batteries is also of concern. Silver, manganese, cadmium, nickel, zinc, and lithium are all used in their composition. Mercury is another consideration as it may be absorbed into the circulation[6,14] (figure 6). The amount of mercury (usually in the form of elemental mercury or as mercuric oxide) within a battery ranges from 0.09 to 21 g. The lethal dose of the toxic form of mercury (as chloride or oxide) for humans is not known exactly, but is estimated to be 1.0 to 4.0 g.

Figure 6.

Iatrogenic intraluminal densities. (A) Mercury from a Cantor tube in a 13-year-old boy recovering from an episode of small-bowel obstruction that had been managed with a Cantor tube. Unfortunately, the weighted balloon at the leading end of the tube had ruptured, dispersing mercury into the bowel lumen. (B) Iron pills in the ascending colon of a 46-year-old man with diarrhea. Abdominal radiograph shows a collection of round metallic densities in the right abdomen. These are iron pills that have survived rapid transit through the bowel. Several common medications (calcium, bismuth) contain sufficient radio-opaque ingredients that may be visible on a radiograph.

Figure 6.

Iatrogenic intraluminal densities. (A) Mercury from a Cantor tube in a 13-year-old boy recovering from an episode of small-bowel obstruction that had been managed with a Cantor tube. Unfortunately, the weighted balloon at the leading end of the tube had ruptured, dispersing mercury into the bowel lumen. (B) Iron pills in the ascending colon of a 46-year-old man with diarrhea. Abdominal radiograph shows a collection of round metallic densities in the right abdomen. These are iron pills that have survived rapid transit through the bowel. Several common medications (calcium, bismuth) contain sufficient radio-opaque ingredients that may be visible on a radiograph.

Coins have traditionally been considered relatively inert in their chemistry. A dime (17 mm) or a penny (18 mm) will usually pass through the intestinal tract if there is no hold up in the pharynx or esophagus.[2] In 1982, the copper penny (95% copper, 5% zinc) was replaced by the zinc penny (2.4% copper, 97.6% zinc). The zinc results in chemical reactivity including the development of gastric erosions.

Swallowed, concealed illicit drugs (e.g., crack in vials, cocaine in condoms) can produce a very confusing picture, especially in the absence of a useful history from the patient. These drug couriers, known as "mules" or "body packers," use the gastrointestinal tract to smuggle their cargo undetected by the custom authorities. Imaging may be called upon to examine these suspects without physical intrusion. Occasionally, a courier may be imaged without suspicion because of a medical presentation (such as may occur if a package is disrupted resulting in drug intoxication, or if the packages result in a bowel obstruction). On plain films, bundles of cocaine are visible in up to 90% of cases and appear as multiple uniformly round or oval densities (figure 7). The density of the packet will vary with the wrapping material used (dense aluminum foil versus lucent wax) and the processing of the surrounding balloons or condoms (there may be a tiny amount of air trapped between the layers, producing a lucent rim). In cases of doubt, ultrasonography and computed tomography would be appropriate to further define the suspect material.[2,16,17,18,19]

Figure 7.

Body packers for transportation of illicit drugs. (A) Rectal heroin condoms in a 28-year-old man intercepted at the airport. Abdominal radiograph shows a few lucent structures in the upper rectum that are heroin-filled condoms. (Case courtesy of Dr T. Chakera, Department of Radiology, Royal Perth Hospital, Australia.) (B) Crack cocaine vials in a 21-year-old man with abdominal pain. Supine film shows a cluster of opaque foreign bodies in the mid abdomen. They are vials of crack cocaine, held together in a group by a condom. The surgical staples are evidence of previous small-bowel trauma (by gunshot injury) as is the right pelvic bony deformity. On this occasion, the package of drugs had become impacted at a stricture at the site of prior small-bowel repair. (C) Swallowed heroin packets in a 28-year-old man, a suspected "mule" intercepted at the airport. Abdominal radiograph shows typical appearance of packets of heroin mainly now in the colon. They were wrapped within the mini-condoms (created from the finger portions cut off from rubber gloves) to be smaller and easier to swallow. (Case courtesy of Dr. R. Thompson, Department of Radiology, Sir Charles Gairdner Hospital, Australia). (D) Twist ties (arrows) in the stomach of an 18-year-old man brought into the emergency room by the police because he had become confused and agitated after arrest for suspected drug trafficking. He developed convulsions and hypertension (BP 210/105). Radiographs revealed multiple fine wire coils in the stomach. They are twist ties closing small plastic packets of cocaine, evidence of the drugs he had swallowed to escape detection on his person. At least one of these ties appears to have unfurled.

Figure 7.

Body packers for transportation of illicit drugs. (A) Rectal heroin condoms in a 28-year-old man intercepted at the airport. Abdominal radiograph shows a few lucent structures in the upper rectum that are heroin-filled condoms. (Case courtesy of Dr T. Chakera, Department of Radiology, Royal Perth Hospital, Australia.) (B) Crack cocaine vials in a 21-year-old man with abdominal pain. Supine film shows a cluster of opaque foreign bodies in the mid abdomen. They are vials of crack cocaine, held together in a group by a condom. The surgical staples are evidence of previous small-bowel trauma (by gunshot injury) as is the right pelvic bony deformity. On this occasion, the package of drugs had become impacted at a stricture at the site of prior small-bowel repair. (C) Swallowed heroin packets in a 28-year-old man, a suspected "mule" intercepted at the airport. Abdominal radiograph shows typical appearance of packets of heroin mainly now in the colon. They were wrapped within the mini-condoms (created from the finger portions cut off from rubber gloves) to be smaller and easier to swallow. (Case courtesy of Dr. R. Thompson, Department of Radiology, Sir Charles Gairdner Hospital, Australia). (D) Twist ties (arrows) in the stomach of an 18-year-old man brought into the emergency room by the police because he had become confused and agitated after arrest for suspected drug trafficking. He developed convulsions and hypertension (BP 210/105). Radiographs revealed multiple fine wire coils in the stomach. They are twist ties closing small plastic packets of cocaine, evidence of the drugs he had swallowed to escape detection on his person. At least one of these ties appears to have unfurled.

Figure 7.

Body packers for transportation of illicit drugs. (A) Rectal heroin condoms in a 28-year-old man intercepted at the airport. Abdominal radiograph shows a few lucent structures in the upper rectum that are heroin-filled condoms. (Case courtesy of Dr T. Chakera, Department of Radiology, Royal Perth Hospital, Australia.) (B) Crack cocaine vials in a 21-year-old man with abdominal pain. Supine film shows a cluster of opaque foreign bodies in the mid abdomen. They are vials of crack cocaine, held together in a group by a condom. The surgical staples are evidence of previous small-bowel trauma (by gunshot injury) as is the right pelvic bony deformity. On this occasion, the package of drugs had become impacted at a stricture at the site of prior small-bowel repair. (C) Swallowed heroin packets in a 28-year-old man, a suspected "mule" intercepted at the airport. Abdominal radiograph shows typical appearance of packets of heroin mainly now in the colon. They were wrapped within the mini-condoms (created from the finger portions cut off from rubber gloves) to be smaller and easier to swallow. (Case courtesy of Dr. R. Thompson, Department of Radiology, Sir Charles Gairdner Hospital, Australia). (D) Twist ties (arrows) in the stomach of an 18-year-old man brought into the emergency room by the police because he had become confused and agitated after arrest for suspected drug trafficking. He developed convulsions and hypertension (BP 210/105). Radiographs revealed multiple fine wire coils in the stomach. They are twist ties closing small plastic packets of cocaine, evidence of the drugs he had swallowed to escape detection on his person. At least one of these ties appears to have unfurled.

Figure 7.

Body packers for transportation of illicit drugs. (A) Rectal heroin condoms in a 28-year-old man intercepted at the airport. Abdominal radiograph shows a few lucent structures in the upper rectum that are heroin-filled condoms. (Case courtesy of Dr T. Chakera, Department of Radiology, Royal Perth Hospital, Australia.) (B) Crack cocaine vials in a 21-year-old man with abdominal pain. Supine film shows a cluster of opaque foreign bodies in the mid abdomen. They are vials of crack cocaine, held together in a group by a condom. The surgical staples are evidence of previous small-bowel trauma (by gunshot injury) as is the right pelvic bony deformity. On this occasion, the package of drugs had become impacted at a stricture at the site of prior small-bowel repair. (C) Swallowed heroin packets in a 28-year-old man, a suspected "mule" intercepted at the airport. Abdominal radiograph shows typical appearance of packets of heroin mainly now in the colon. They were wrapped within the mini-condoms (created from the finger portions cut off from rubber gloves) to be smaller and easier to swallow. (Case courtesy of Dr. R. Thompson, Department of Radiology, Sir Charles Gairdner Hospital, Australia). (D) Twist ties (arrows) in the stomach of an 18-year-old man brought into the emergency room by the police because he had become confused and agitated after arrest for suspected drug trafficking. He developed convulsions and hypertension (BP 210/105). Radiographs revealed multiple fine wire coils in the stomach. They are twist ties closing small plastic packets of cocaine, evidence of the drugs he had swallowed to escape detection on his person. At least one of these ties appears to have unfurled.

A few therapeutic options are available for the radiologist to assist in the management of some of these patients. A bolus impacted at the gastroesophageal junction may pass spontaneously during a barium swallow, aided by IV glucagon to relieve sphincter spasm, and effervescent agents. A Foley balloon catheter may be introduced and passed with fluoro-scopic guidance past the offending bolus. The balloon can then be distended and the foreign body can be extracted from the esophagus as the catheter is withdrawn. Occasionally, a magnet-tipped probe can be passed fluoroscopically into the esophagus or stomach to retrieve a metal foreign body.[22] Considerable care must be taken with impactions of >24-hour duration because of the potential for esophageal perforation from pressure necrosis.[3]

A few pathological conditions may produce a radiographic appearance mis-taken for foreign bodies. The presence of intestinal infestation by Ascaris lumbricoides may produce a radiographic appearance mistaken for foreign bodies (fragments of catheter or other tubing). These parasites appear as long, thin, tubular filling defects in the bowel (figure 8). They might be particularly confusing when seen on CT, as the worm will only be seen in small sections on multiple images.[23] Sonography of ascariasis has also been described; this modality is useful in its ability to visualize the curling movements of the worms, establishing the diagnosis with certainty.[24] Luminal filling defects may also be seen with bezoars (figure 4C), gallstone ileus (figure 9), and polypoid tumors.

Figure 4.

Gastric ingested foreign bodies. (A) A battery in the stomach of a 23-year-old man, frequent attendee of the emergency room. Abdominal radiograph shows a AA dry-cell battery in the stomach. (B) Toothbrushes (arrow) in the stomach of a 40-year-old mentally ill man who has tried to swallow a variety of objects. On this occasion, these abdominal films obtained after a Gastrografin swallow shows two gastric toothbrushes, rendered visible due to the contrast trapped in the base of the bristles and the rough textured part of the handle. (C) Gastric bezoar in a 82-year-old man with Bilroth 1 resection 30 years ago for peptic ulcer, who now has a long history of epigastric discomfort after meals. Barium study shows slight narrowing at the gastro-duodenal anastomosis. There is a large gastric bezoar. Occasionally, a fragment of the bezoar impacts in the anastomosis precipitating the acute obstructive symptoms.

Figure 4.

Gastric ingested foreign bodies. (A) A battery in the stomach of a 23-year-old man, frequent attendee of the emergency room. Abdominal radiograph shows a AA dry-cell battery in the stomach. (B) Toothbrushes (arrow) in the stomach of a 40-year-old mentally ill man who has tried to swallow a variety of objects. On this occasion, these abdominal films obtained after a Gastrografin swallow shows two gastric toothbrushes, rendered visible due to the contrast trapped in the base of the bristles and the rough textured part of the handle. (C) Gastric bezoar in a 82-year-old man with Bilroth 1 resection 30 years ago for peptic ulcer, who now has a long history of epigastric discomfort after meals. Barium study shows slight narrowing at the gastro-duodenal anastomosis. There is a large gastric bezoar. Occasionally, a fragment of the bezoar impacts in the anastomosis precipitating the acute obstructive symptoms.

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