Correspondence

Medical Mystery — The Answer

N Engl J Med 2004; 350:839February 19, 2004

Article

To the Editor:

The medical mystery in the January 1 issue1 involved a 62-year-old man who had a history of psychosis and who presented with an ileus. An abdominal radiograph revealed a ptotic gastric fundus filled with a very large, radiopaque density (Figure 1AFigure 1An Abdominal Radiograph Showing a Ptotic Gastric Fundus Filled with a Very Large, Radiopaque Density (Panel A, Arrows), Identified as a Collection of Coins, Necklaces, and Needles at Laparotomy (Panel B).). At laparotomy, the distended stomach was found to contain 5.5 kg of coins, necklaces, and needles (Figure 1B). A partial gastrectomy with Braun's anastomosis was performed because of pressure necrosis. Postoperative complications included septic shock and multiple-organ failure, which resulted in the patient's death on the 12th postoperative day.

Close to 90 percent of ingested foreign bodies pass spontaneously, but 10 to 20 percent require endoscopic removal. Removal through laparoscopy or laparotomy is needed in 1 percent of cases. Large or sharp foreign bodies, as in this patient, may obstruct or perforate the stomach or digestive tract and cause death.

Bruno François, M.D.
Association des Réanimateurs, 87000 Limoges, France

Olivier Brenet, M.D.
Association des Réanimateurs, 49300 Cholet, France

1 References