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Foreign Body Ingestion: A Colorful Dilemma

  • Michael Chew
    Correspondence
    Correspondence: Address correspondence to: Michael Chew, MD, Digestive Diseases, P.O. Box 208019, New Haven, Connecticut 06520.
    Affiliations
    Department of Internal Medicine, Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut
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  • James Farrell
    Affiliations
    Department of Internal Medicine, Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut

    Yale Center for Pancreatic Disease, Center for Advanced Endoscopy, Yale School of Medicine, New Haven, Connecticut
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  • Michelle L. Hughes
    Affiliations
    Department of Internal Medicine, Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut
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Open AccessPublished:April 21, 2022DOI:https://doi.org/10.1016/j.gastha.2022.04.004
      A 27-year-old woman with a history of schizoaffective disorder presented from an inpatient psychiatric facility with an acute onset of nausea, vomiting, abdominal pain, and early satiety. On examination, vital signs were stable. Abdomen was distended and diffusely tender to palpation but without peritoneal signs. Computed tomography scan showed multiple, well-circumscribed lesions of varying density within the gastric body but no evidence of perforation or obstruction (Figure A). Upper endoscopy was performed. The esophagus was normal in appearance. Upon entering the stomach, there were numerous crayons layered in the gastric fundus and gastric body (Figure B). An overtube was placed into the stomach under endoscopic guidance, and a total of 81 full-size and intact crayons, crayon wrappers, and a pen were removed with a snare (Figure C). Guidelines on foreign bodies in the stomach recommend urgent removal of sharp or long (>5 cm length) and/or wide (>2.5 cm diameter) objects with surgical consultation if the foreign body is unable to be retrieved endoscopically. The patient did well after the procedure and was discharged back to inpatient psychiatric facility.