An 80-year-old woman, who had just eaten a shortcake, realized that she had accidentally
eaten the cakeʼs decorative paper. She did not initially experience any symptoms but,
2 months later, she was unable to eat and became bedridden. A short time later, she
was admitted to the neurosurgery department of our hospital with impaired consciousness.
She was diagnosed with extensive cerebral embolism and was treated conservatively.
Her level of consciousness improved and she was started on tube feeding. A few days
later, she passed a large amount of melena and was referred to the gastroenterology
department.
An emergency lower gastrointestinal endoscopy revealed a large ulcer in the rectum
and a visible vessel in the same area, which was bleeding ([Fig. 1 a]). The bleeding could not be stopped with a clip and the vessel was therefore cauterized
with hemostatic forceps. At the same time, a 2-cm square foreign body was noted in
the rectum ([Fig. 1 b]). Hemostasis was confirmed on repeat endoscopy the following day ([Fig. 1 c]). The foreign body, which was a 2-cm square of synthetic paper that was hard and
sharp on all sides, was safely removed, having been ligated with a detachable snare
for polypectomy and made into a cylindrical shape ([Fig. 1 d]; [Video 1]). Synthetic paper contains a synthetic resin; it had barely been digested and had
hard sharp corners that were very dangerous ([Fig. 2]). A computed tomography scan that had been performed prior to the endoscopy had
failed to detect the foreign body.
Fig. 1 Endoscopic views in an elderly woman with melena showing: a a large ulcer with a visible vessel in the rectum; b a 2-cm square of synthetic paper that was found in the rectum after hemostasis had
been achieved; c confirmation that hemostasis had been achieved the following day; d a detachable snare being used to change the foreign body into a cylindrical shape
so that it can be safely removed from the rectum.
Video 1 A 2-cm square of synthetic paper with hard and sharp edges that was found in the
rectum of an elderly woman is ligated with a detachable snare, transforming it into
a cylindrical shape that was then safely removed.
Fig. 2 Photograph of the extracted synthetic paper, which had hard and sharp edges.
We have previously used a detachable snare to endoscopically remove a press-through
package from the esophagus [1]. The detachable snare for polypectomy was considered an effective and safe method
of removing a hard, rectangular sheets such as these from the gastrointestinal tract.
There is also a need to raise widespread awareness about the accidental ingestion
of foreign objects by the elderly, as occurred in this case.
Endoscopy_UCTN_Code_CCL_1AD_2AH
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