Top 10 Foreign Bodies

From time to time little things get lost. Whether you are playing billiards naked in the dark; counting money with your tongue; battling with an electric rolling pin; or just ‘slipping‘ whilst in the shower….

You may be unlucky enough to find yourself in the emergency department desperately trying to manifest a more tangible excuse for foreign body concealment. These are my top 10 foreign bodies, found on X-ray.

10. Toxic Ingestion

Iron tablets are among a select group of preparations which are radio-opaque. An X-ray can be a great way of determining the exact number of tablets ingested of this potentially lethal substance.

Tox Iron tablet ingestion LITFL
Iron Tablet Overdose
Tox potassium tablet overdose ingestion LITFL
Potassium tablet (60) ingestion

Fortunately mercury thermometers are going out of fashion. Asa general rule – try not to sneeze as your temperature is being taken…

Tox Mercury ingestion LITFL
Mercury Ingestion from shattered thermometer

Not uncommon for medication ingestions to lead to a faecaloma – a hardened, relatively immobile, tumour-like mass of accumulated faeces, usually found in the rectosigmoid region….

Faecoma faecaloma fecoma fecaloma
Fecoma or fecaloma

9. Mmmm that looks yummy Mummy

Ear-rings, paper clips, screws and spoons are not liable to degrade quickly upon ingestion…

8. Money in the Bank

7. Mea culpa

Sometimes foreign body penetration occurs through no fault of the patient…

RMB intubation
Right Main Bronchus (RMB) intubation

Nasogastric tube in Bronchi
Nasogastric tube (NGT) in Bronchi

6. Not the Full 8-ball

Warning: Playing billiards, naked, in the rain…at night – may result in serious injury…allegedly

Billiard ball Foreign body 8 ball LITFL
Wrong pocket…

5. Summer holiday souvenir

The holiday that kept on giving. This chap cut his hand on glass hidden in the sand, and 3 months later wondered what was causing his hand to be increasingly swollen and painful…

Hand Foreign Body XR Shell AP
Hand Foreign Body XR Shell Lateral

4. Beware the Button Battery

Button battery ingestion is one of the leading causes of death in paediatric poisoning and this has sharply risen from 2016 despite manufacturing warnings and the addition of tape to cover the negative side (not very useful once you’ve removed that to place it in your device).

3 The Classics

Who knew there were so many varieties of electric rolling pins?

2. Serial Offender

Operation is often the only way to determine the exact intra-colonic shopping list, especially with chronic eclectic ingestion. Retrieved objects included: spoons, nail clippers, batteries, tweezers, pens and a transistor radio

Multiple Abdominal Foreign Bodies

Surgeons in Rotterdam were flabbergasted when X-rays revealed 78 different items of cutlery in this patient’s stomach. Again, it is hard to comprehend the mind-boggling number of utensils consumed until they are laid out on the operating table.

Cutlery set LITFL XR
Cutlery set LITFL Post Op
78-piece dinner service, one owner

1. “Can’t Beat the Feeling”

This is my favorite.

Mainly due to elaborate scenario concocted to explain the mysterious materialization of a 375mL effervescent drink bottle where the sun don’t shine.

As a result of the alleged causative event, the LITFL would like to issue the following statement:

Warning: Narrow necked bottles should not be used to collect urine specimens

Bottom Bottle
Bottom Bottle Lateral

BA MA (Oxon) MBChB (Edin) FACEM FFSEM. Emergency physician, Sir Charles Gairdner Hospital.  Passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | Twitter |

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