What Happens When the Digested Screw Does Not Come Out of Ileum?

Adults with foreign body ingestion are mainly secondary to psychiatric disorders, alcoholic intoxication, and secondary gains. Conservative management without any intervention is successful in 80% of the ingested foreign bodies. Risk factors for complication include sharp objects, objects larger than 6 mm, recurrent ingestion, and previous gastrointestinal tract surgeries. Sharp objects specifically account for 35% perforation rates and impactions, most commonly at the ileocecal valve. There is limited evidence on the role of colonoscopy after the distal migration of foreign bodies into the ileum and colon. In our case report, we present a case of a 53-year-old-male with a history of recurrent foreign body ingestion secondary to a multitude of psychiatric disorders. It describes multiple foreign body ingestions, leading to failure of a screw at the ileocecal valve at day 5 of ingestion, despite conservative management with serial bowel preparations and abdominal radiographs. There is limited evidence on the management of foreign bodies after distal migration to the ligament of Trietz. Existing literature and guidelines suggest surgically managing the sharp foreign bodies after the failure of conservative management for three to five days. In the case report, we have attempted to emphasize the noninvasive, colonoscopic approach as initial management in removing impacted foreign bodies. This abstract has been presented and accepted at the American college of gastroenterology meeting held from October 22, 2021, to October 27, 2021, in Las Vegas as a poster.