What is the Best Way to Remove Nails from a Stomach?

The common refrigerator magnet can aide in endoscopic retrieval of ingested metal objects, researchers show in the September issue of Clinical Gastroenterology and Hepatology.

Wilson T. Kwong and John T. Chang describe the case of a 41-year-old woman with a history of depression who arrived at the emergency department after intentionally swallowing metal nails. This was her third episode of foreign body ingestion, with the prior episodes involving razor blades and staples.

An abdominal radiograph showed 8 nails in her stomach, without evidence of pneumoperitoneum (see below figure).

Radiograph of 8 nails within the stomach

Radiograph of 8 nails within the stomach

The physicians performed esophagogastroduodenoscopy, but the large amount of solid food and debris in the stomach precluded visualization of the nails. Despite a nearly 2-hour attempt to remove the solid food using a Roth Net retrieval device, only 1 nail was found and recovered.

Kwong and Chang reasoned that endoscopic insertion of a magnet might pull the hidden nails out of the food matter—and that a refrigerator magnet would suffice. A magnet they found in the Emergency Department staff lounge was sterilized, placed into the Roth Net, and advanced under endoscopic guidance into the stomach.

When the magnet entered the food mass, several nails immediately attached to it, and the remainder were retrieved in this manner. A repeat abdominal radiograph confirmed removal of all ingested nails.

In large published case series of foreign body ingestions, many involve objects that contain metal. Endoscopy is required for up to 90% of patients, and success rates range from 48% to 94%. Reasons for failure include technical challenges caused by number or shape of objects, their location, and the presence of gastric contents or food.

Kwong and Chang propose that magnets be used to retrieve metal objects that are not easily visualized, are difficult to grab with the usual endoscopic devices, or are too small or numerous. The approach could also be used to recover ingested magnets or disk batteries, which can cause perforations and fistulas.

Additional advantages of magnet-assisted endoscopic retrieval include its ability to collect multiple objects simultaneously, without direct visualization, or objects that are difficult to grasp with endoscopic devices, because of a difficult position or physical characteristics of the foreign body.

After the nails were removed, the patient underwent psychiatric evaluation and was discharged after 10 days of hospitalization. One month later, however, she reappeared at the emergency department after swallowing 30 nails. Esophagogastroduodenoscopy revealed solid food obscuring the nails, and a magnet, in the Roth Net, was again used to remove the nails. The authors conclude that a magnet is a useful tool for foreign body retrieval.

Read the article online.
Kwong WT, Chang JT. Endoscopic retrieval of ingested nails using a refrigerator magnet. Clin Gastroenterol Hepatol 2013;11:A24.

2 Comments

  1. Avatar
    Anonymous September 09, 2013

    Do you think she has an iron deficiency?

  2. Avatar
    zassbdr@gmail.com April 19, 2014

    De verdad que estaba buscando esto, la verdad que es bueno conseguir sitios como este, ahora mismo comenzaré un proyecto bastante relacionado con este tema.

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