There was a young man who swallowed a compass
The whole world gagged when a surgeon in Israel revealed that a patient swallowed the fork she was using to dislodge a bug from her throat. Now, an Edmonton doctor shows Chris Zdeb his collection of objects retrieved from patients.
 
Chris Zdeb  
CanWest News Service


Sunday, July 27, 2003

CREDIT: Brian Gavriloff, CanWest News Service
 
EDMONTON - You weren't alone if you thought of the old lady who swallowed a spider when you read the bizarre news story about a 32-year-old woman who swallowed both a winged cockroach and the fork she was using to try to remove it from her throat.

It was "a bit strange story," admitted Dr. Nikola Adid, a surgeon at the Poria Hospital in Tiberias, Israel, who removed the fork with laparoscopic surgery.

How could she swallow something as big as a fork? Do we all have this hidden talent? you wonder, knowing people who gag trying to swallow a pill.

Dr. Adrian Jones at Edmonton's Stollery Children's Hospital says he chuckled on reading about the woman, the cockroach and the fork. As a pediatric gastroenterologist (kids' stomach/intestines specialist), he's heard of many such cases and has pulled many interesting things out of children's innards.

Some of the things he's fished out that patients didn't keep as souvenirs are displayed in what Dr. Jones calls "the frame of infamy," which hangs on a wall in a hospital clinic.

There are coins from pennies to quarters, keys, Lego pieces, batteries -- double A, triple A and buttons -- nails, a hairpin, a backpack clasp and a geometry compass.

Dr. Jones said a bored teenage boy, daydreaming in his math class, was absent-mindedly toying with the compass when it fell into his mouth, hit the back of his throat and was reflexively swallowed.

Luckily the compass was closed and went in blunt-end first so it didn't stick in his windpipe or oesophagus. But, because it was large and sharp, it had to be removed from the boy's stomach, Dr. Jones said.

We all have the potential to swallow a math compass or a fork -- the esophagus is a muscular tube that can distend. An adult can easily accommodate a gastroscope or probe, which is nine millimetres wide. The esophagus of a child, two and younger, can take a six mm scope. But most people will choke on a large object, Dr. Jones said. It depends on the strength of your gag reflex and on your ability to swallow enormous lumps of food.

Dr. Jones suspects the guy who regularly wins the Coney Island hot-dog-eating contest has a weak gag reflex and can gulp down unchewed food.

But back to forks.

"We've had some infamous people here (at the adjoining University Hospital) who have repeatedly swallowed those types of things -- knives, forks, spoons," said Dr. Jones.

Prisoners routinely swallow things like scissors, razors, utensils, whatever they can get their hands on, so they can go to the hospital for some personalized attention, he says. Others are mentally disturbed in one way or another. They, too, swallow things to get attention.

Criminals swallow drug evidence when being arrested by police. Dr. Jones said it took him hours to remove 13 bags of crack and cocaine powder from the large bowel of one young offender who 'fessed up when he feared the bags would split, and kill him.

Most of the swallowers Dr. Jones sees are young children who put bits and pieces of things they find lying around the house in their mouths.

"Once it's past the back of the tongue and in the esophagus, you cannot control it. It's very difficult to regurgitate it back up again, especially a coin, because it's usually impacted in the wall. It's gone," said Dr. Jones.

Kids who swallow things like meat that regularly get stuck halfway down the esophagus may actually have a condition of the esophagus that results in spasms.

The disease has only recently been recognized in North America, said Dr. Jones, who figures he's seen about 30 such children in the last two years.

There are two common ways to retrieve a swallowed object. If it is sharp, like a fish or chicken bone, it usually lodges at the back of the throat where it can be seen and easily pulled out.

Past this point, Dr. Jones uses a gastroscope, a flexible, lighted instrument that is put through the mouth and down the esophagus to view the digestive tract.

A retractable loop or rubber basket that can be extended from one end of the gastroscope ensnares the foreign object, allowing it to be pulled out. The patient is under general anesthetic. The procedure usually takes five to 10 minutes.

Very rarely -- when an object is sharp at both ends -- does a patient have to be cut, said Dr. Jones. He was surprised the fork woman's doctor used laparoscopic surgery, a procedure performed through a tiny incision in the woman's abdomen.

Not all objects swallowed are removed. If doctors are fairly certain the objects will come out on their own, they simply wait.

Batteries are a special concern because of the acid inside, which can rupture and burn the esophagus, scarring it permanently. Button batteries can corrode, or they can stick in the esophagus and short out, causing an electrical burn.

The most dangerous thing is caustic material, like oven or drain cleaner or lye, because it eats holes in every internal body part it comes in contact with, Dr. Jones said.

His advice should you have a large insect jump or fly into your throat is this: Swallow it. Grab a drink of water and wash it down. By the time the fork woman's doctor got to the fork, the cockroach had been digested.

By the way, the woman in Israel who swallowed the fork fared much better than the old woman in the ditty, who died after her career swallowing larger and larger animals. Dr. Adid reported that his patient was recovering well.