A 3-year-old boy had his teeth cleaned by his mother and wanted to play with the dental floss afterwards. Half an hour later, the mother could not find the dental floss and asked her son where it was. The boy pointed to his mouth and said that he “am-am” the floss. The mother brought her son to the ER.

Physical Examination: Vital signs are stable and child looks at baseline. No dental floss in the mouth.

1. What would you do? Would you search the medical literature?

2. What did you learn from this case?

3. Final diagnosis?

A 24-year-old female presented to the emergency room (ER) with a complaint of swallowing a pen two days ago. She has had vomiting and epigastric pain since then. The patient has a long history of similar behavior in the past. During the last admission one month ago, she had an esophagogastroduodenoscopy (EGD) with a pen removal followed by a spoon ingestion on the ward, requiring a second endoscopy. She also reports eating “a call button” at another facility recently, “they said it was in my colon.” She denies being suicidal.

Past medical history: Post-traumatic stress disorder (PTSD), depression, intentional foreign body (FB) ingestions, and heroin abuse.

Past surgical history: Open foreign body (FB) removal 4 times in the past.

Medications: None.

Social history: Smoking, heroin abuse.

Physical examination: Vital signs – stable. Normal examination.

Complete blood count (CBC) and basic metabolic panel (BMP) were normal.

*Previous X-ray from one month ago: The call button is located in the right upper quadrant, ejecting over both the duodenum and colon. There is no free air. The bowel gas pattern is non-obstructive. There is a right-sided groin catheter*

*Current Plain frontal supine radiograph of the abdomen: Excessive stool is present in the colon. There is a right-sided groin catheter. Overlying the stomach or perhaps within the stomach is a linear lucency measuring approximately 12.5 cm. It has a metal tip. Plain X-ray films were reviewed with radiology: there was a metallic FB in the stomach that looked like a pen tip, there was also a metallic FB in transverse colon, no evidence of perforation or obstruction.*

1. What would you do? Would you search the medical literature?
2. What did you learn from this case?

3. Final diagnosis?