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Doctors removed eight nails from a woman’s colon using cap-assisted colonoscopy after the objects remained near the ileocecal valve for four days. The case report describes only minor superficial abrasions, but the authors say the technique carries perforation risks and requires experienced endoscopists and surgical backup.
Doctors removed eight swallowed nails from a woman’s colon with cap-assisted colonoscopy after the objects remained near the ileocecal valve for four days, according to a case report in BMJ Case Reports. The procedure left only minor superficial abrasions, the researchers reported, while cautioning that sharp-object removal can cause perforation and should be handled by experienced endoscopists with surgical backup available.
The patient, a woman in her 30s receiving psychiatric care, came to medical attention with persistent abdominal pain after intentionally swallowing multiple nails. She had a history of pica and anxiety disorders and, according to the report, this was her sixth episode of foreign-body ingestion in one year. The nails had reached the lower digestive tract, where the small and large intestines meet.
Doctors initially monitored her without a procedure. Her care included bowel rest, polyethylene glycol therapy and abdominal X-rays every 12 hours. The nails moved from the middle of the abdomen to the right lower quadrant and clustered near the ileocecal valve. After four days without spontaneous passage, the team proceeded with colonoscopy.
The endoscopists used a short, hard, transparent cap fitted to the end of the scope. They removed all eight nails with a snare, taking care to secure the sharp ends beneath the cap. The examination afterward found minor superficial abrasions to the colon’s lining. Psychiatry was consulted and recommended admission, but the patient refused. The report says she was followed as an outpatient and had no further complications from the colonoscopy at one-year follow-up.
A Lower-GI Option for Sharp Objects
Sharp objects lodged in the colon can injure or perforate the digestive tract, while nails may be difficult to grasp because of their shape. The case offers a documented example of doctors retrieving such objects through the colon rather than relying on continued observation or surgery. It does not establish that the approach is safe for all patients: the authors describe it as a possible option for clinically stable patients without signs of perforation or peritonitis, with surgical support ready.
The researchers said most swallowed foreign objects pass without intervention, but endoscopic retrieval may be considered when an object does not pass or when its sharp edges pose added risk. This case also underscores how the object’s location and movement can shape the choice of treatment.
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From Monitoring to Colonoscopy
About 80% of ingested foreign bodies pass spontaneously, according to the case report’s authors. They noted that sharp objects can raise the risk of perforation and that nails may be especially challenging to retrieve endoscopically, sometimes requiring surgery. In this patient, doctors first chose conservative management because the nails were considered too far along for safe endoscopic removal at that point.
A cap attached to the colonoscope’s tip can help protect the lining and improve visibility. The authors said only a few reports have described removing foreign bodies from the lower gastrointestinal tract, including with cap-assisted colonoscopy. The patient’s case was reported by researchers including Bhoowit Lerttiendamrong, MD, of the University of Connecticut School of Medicine, who discussed it with MedPage Today.
““It’s pretty rare to have a foreign body that goes all the way down to the lower GI system, and even rarer that sharp foreign bodies go down that far.””
— Bhoowit Lerttiendamrong, MD, speaking to MedPage Today
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Limits of a Single Case
The report describes one patient and does not establish how often cap-assisted colonoscopy succeeds or how its risks compare with continued observation or surgery. Lerttiendamrong told MedPage Today that the procedure is not widely proven and that there is no specific guideline for cases like this. The authors also noted that advancing a scope with a cap can be difficult in a tortuous colon, and that the cap itself may cause injury.
The report does not give further detail on the patient’s longer-term psychiatric care or whether she had another episode of foreign-body ingestion after the one-year follow-up.
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Follow-Up and Clinical Judgment
The patient was being followed as an outpatient after refusing the recommended hospital admission, and the report recorded no further colonoscopy-related complications at one year. The case authors said cap-assisted retrieval should be performed only by experienced endoscopists, with surgical backup available. Whether the technique becomes more widely used will depend on further clinical reports and evidence about its risks and outcomes.
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Key Questions
How many nails did doctors remove?
Doctors removed eight nails using a snare during colonoscopy, according to the case report.
Where were the nails lodged?
The nails had clustered near the ileocecal valve, where the small intestine connects to the large intestine.
Why did doctors wait before performing colonoscopy?
The team initially used conservative care and serial X-rays. They proceeded after four days without the nails passing and imaging showed them near the ileocecal valve.
Did the procedure injure the patient’s colon?
The report says examination after removal found minor superficial abrasions. It reported no further colonoscopy-related complications at one-year follow-up.
Can this method be used for other patients?
The authors described it as a possible option for selected, clinically stable patients without signs of perforation or peritonitis. They cautioned that the procedure carries risks and should be done by experienced endoscopists with surgical backup; one case does not establish broad safety or effectiveness.
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