Abstract
The case involved a 27-year-old man who had mental retardation due to congenital chromosome aberration (details unknown) and had undergone repeated endoscopic removals for pica. From the middle of March 2008 when he had high fever, his eating habit had changed and he was referred to the Department of Gastroenterology in our hospital early in April. Plain X-ray examination revealed sharp metallic foreign bodies (needles), with the diameter of 2 mm and the length of 5 cm, in the neck and the abdomen. He was referred to our department for surgery and underwent emergency surgery on the same day. A needle in the neck was found to be present at the entrance part of the esophagus about 20 cm distal from the incisor. The needle was pushed by hands from the outside of the esophageal wall to the inside of the esophagus and it was removed by using hypopharyngoscopy. Then the inspection of the abdominal cavity under laparotomy disclosed another two needles, which were not in the intestines but one of which had escaped to the left paracolic gutter and the remaining to the Douglas pouch. The needles were removed.
In this patient, intestinal perforation due to the needles had occurred but it might not cause generalized peritonitis, because the tips of the needles were too sharp to induce generalized peritonitis and the perforated intestinal wall spontaneously and rapidly closed.
