A Massive Stone Ingestion

• Type of Material: Article
• Authors: Amneet K. Hans, Emory University; Jason Brown, Emory University; Emad Qayed, Emory University
• Language: English
• Date: 2021-11-01
• Publisher: American College of Gastroenterology
• Publication Version: Final Published Version
• Copyright Statement: © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.14309/crj.0000000000000707
• Title of Journal or Parent Work: ACG Case Reports Journal
• Volume: 8
• Issue: 11
• Grant/Funding Information: None to report.
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

A 48-year-old man with a history of bipolar disorder and schizophrenia presented to the emergency department with nausea and diffuse abdominal pain. He had ingested a large number of stones in a suicide attempt. Radiographic findings at admission revealed innumerable foreign bodies throughout the stomach and right colon, without evidence of obstruction or perforation (Figure ​(Figure1).1). The patient was hospitalized for serial abdominal examinations, and x-rays were performed. Repeat imaging 2 days after admission revealed innumerous stones throughout the colon with only few remaining in the stomach (Figure ​(Figure2).2). His abdominal examination remained benign, and he denied pain. On day 8, x-ray showed 3 retained stones in the stomach; the rest had passed spontaneously. An esophagogastroduodenoscopy was performed revealing 2 round stones each measuring 3 cm in diameter within the antrum (Figure ​(Figure3).3). Initial attempts to extract the stones using a retrieval net were unsuccessful because of significant resistance at the lower esophageal sphincter. A 50-cm gastric overtube was then inserted into the stomach allowing for scope reinsertion and grasping of the stone by the retrieval net. The scope was withdrawn to the lumen of the overtube, and the retrieval net–held stone was pulled tightly to the tip of the overtube (Figure ​(Figure4).4). Finally, the scope, overtube, and retrieval net were withdrawn through the mouth as 1 unit. This process was repeated for the second stone. The third stone passed spontaneously, and no surgical intervention was required.