General surgery registrar Dr Talia Shepherd had attributed her upper abdominal pain to her gallbladder – later, sent her home after the pain subsided.
"But she presented two days later with very severe abdominal pain that led us to put her into a CT scanner straight away and then take her to theatre based on what we found," Dr Shepherd said.
10-year-old orthodontic wire found
"We saw that in the middle quite a large loop of dilated, unhappy bowel with this foreign body that could possibly have been a fish bone, because that is what we see more commonly,” explained Shepherd. The patient had to be wheeled to the theatre right away to extract whatever it was, as she felt unwell.
What showed up on the CT scan was unfathomable – a seven-centimetre piece of orthodontic wire, which was left after she removed her braces ten years ago. It had punctured several places in her small intestine and thus, caused a small bowel volvulus where the intestine twisted around itself.
"When we extracted it, we could still see the actual indent of the braces on the wire," said the doctor.
The woman, who is expected to recover completely, could not recall swallowing a wire or losing a piece of her braces. The wire had gone unnoticed all these years, and as Dr Shepherd said, "That's what makes the case so unusual."
"I think it was probably just sitting there in her stomach the whole time, and then when the small bowel was punctured – that's when the pain started," she said.
Despite being in her abdomen for a long period, Dr Shepherd said, "She is now well and carrying on with her life."
An uncommon case that should not alarm people with braces
"The chances of swallowing a wire from your braces is very low," she said. "There might be a higher chance if you're sedated and undergo a dental procedure. But, this is a very unusual case."
Dr Pat Raymond, a gastroenterologist and assistant professor of clinical internal medicine at Eastern Virginia Medical School, agrees that the case is unusual because the patient had not the faintest idea of ever swallowing anything of that nature.
"Usually, when people have an injury related to swallowing something, they remember accidentally swallowing it or intentionally swallowing it," said Raymond, who is also a spokeswoman for the American College of Gastroenterology.
"But that she doesn't remember getting a relatively large piece of wire down there a decade before is strange."
"It's incredibly common in my profession to see people who have swallowed things," Dr Raymond said. "The objects often vary based on whether things are swallowed intentionally or by mistake."
For instance, it is common for drug smugglers to push drugs down their throats to evade the law. A man had ingested 110 cocaine packets and while some of it passed through his system, another part had to be removed at the hospital.
As for accidental ingestions, Raymond said it usually occurs when people place things in their mouths to temporarily hold them, such as bobby pins or screws.
In recent years, there have been numerous publications highlighting a list of unusual objects either intentionally or accidentally swallowed, such as a toothbrush, a fitness tracker, a lighter, an LED bulk and dentures.
In one bizarre case, a woman had accidentally swallowed an ink pen, which was removed from her stomach 25 years after. Miraculously, the pen could still be used, mind you!
Surgery only required for those with sharp objects or extreme pain
Most often, doctors treat patients that have ingested foreign objects by allowing the swallowed object just to pass through the body, said Dr J. Sumner Bell III, a gastroenterologist and member of the American Gastroenterological Association.
Usually, an endoscope will be used to spot and remove the item from the oesophagus or stomach except for patients in extreme pain or those with very sharp objects where surgery is necessary.
"The general rule is that if it passes out of the oesophagus, it's likely to pass through the rest of the intestine without incident," Dr Bell said.
"But if people swallow batteries, children swallow magnets, or sharp objects like razor blades or packages of cocaine, that's where we get involved to actively remove them."
These types of items can cause harm to the patient through perforation inside the body, just like the wire.
If the wire could survive for a long stretch of time, could gum last likewise? Contrary to old wives’ tales that a gum swallowed can last seven years, Dr Raymond said it is completely untrue.
"Gum does not hang out for long in the stomach. Pretty much, the wad of gum is small enough to go from the stomach to the small intestine," Dr Raymond said. "Then it travels downstream, and it comes out the bottom end.
"The time range for gum is about the same as the time range for corn on the cob," she said.
"I tell people if they want to know the average transit time for their GI tract, go eat some sweet corn. Then look for sweet corn. That's about how long gum will take to be digested, too."
So it looks like the stomach does discriminate objects resting in its site. MIMS
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