In and #64258;ammation of the terminal ileum secondary to an embedded plastic sword with ulceration in the ascending colon

Discussion

The working diagnosis was Crohn's disease, and the patient was admitted to the hospital. A gastroenterology consultation was requested. During this evaluation, it was discovered that the patient had been at a bar approximately 10 days before presentation to the emergency room. He recalled swallowing a spearlike mixed-drink plastic sword pick. The patient stated he was uncertain why he did this but reported symptoms of pain 3 to 4 days after ingestion.

Based on the history, a colonoscopy was performed, which revealed a plastic sword pick with the tip and blade in the terminal ileum and the hilt embedded in the proximal ascending colon. The sword was removed cautiously during the colonoscopy. A localized area of mucosa in the terminal ileum was mildly erythematous and nodular. A single 6-mm ulcer was found in the proximal ascending colon at the embedded site.

CONCLUSION

The differential diagnosis for inflammation and wall thickening of the terminal ileum is extensive, including inflammatory, infectious, and neoplastic processes. In a young adult, the most common etiology is Crohn's disease. However, with the right clinical history, foreign bodies should also be considered.