Multiple Metallic Foreign Body Ingestion with Distal Migration Requiring Surgical Extraction: A Case Report

Abstract

Foreign body ingestion is a frequent clinical problem in emergency and gastrointestinal practice. In adults, it may occur in association with psychiatric disorders, substance abuse, or intentional self-harm. Although most ingested foreign bodies pass spontaneously through the gastrointestinal tract, cylindrical battery ingestion is uncommon and may be associated with mechanical obstruction, mucosal injury, leakage, perforation, or fistula formation. We report the case of a 30-year-old male chronic smoker with no significant past medical or surgical history who was admitted two days after the voluntary ingestion of four cylindrical batteries measuring approximately 4 cm each. At presentation, the patient was asymptomatic, with no abdominal pain, vomiting, bowel transit disturbance, or gastrointestinal bleeding. Physical examination showed a soft, non-distended, and non-tender abdomen without peritoneal signs. Abdominal plain radiography demonstrated multiple metallic foreign bodies projected over the peri-umbilical region. Computed tomography confirmed the presence of four metallic-density foreign bodies within the duodenal lumen and showed no evidence of perforation, obstruction, pneumoperitoneum, or intra-abdominal fluid collection. Upper gastrointestinal endoscopy was attempted but failed to retrieve the batteries. Follow-up imaging demonstrated distal migration of the foreign bodies towards the pelvic region. Rectosigmoidoscopy was subsequently performed, but the batteries were not visualised. Because the foreign bodies persisted despite endoscopic management and their exact location remained uncertain, exploratory laparotomy was undertaken. Intraoperative manipulation facilitated distal progression, allowing successful extraction of all four batteries through the rectal route without enterotomy or bowel resection. No perforation, ischemia, or associated gastrointestinal lesion was identified. The postoperative course was uneventful, oral feeding was resumed on the first postoperative day, and the patient was discharged on postoperative day 2. This case highlights the need for individualised management, close radiological follow-up, and timely surgical intervention when endoscopic retrieval fails.