Today's Medical Mysterie

[George K]

This is a CT scan.

You're looking at slices across the body. Top is the front of the patient, the left side of the scan is the right side of the patient. That big thing on the patient's right (scan's left) is the liver.

The doc posts lots of interesting videos...

"If you’re a new follower I always post the answer with explanation the next day. If you’re new to my account—follow me if you want to learn about medical emergencies"

[blondie]

I’m not on Twitter, but I would like to know what those little gremlins are passing from the stomach in to the intestine. Am I seeing this right? Pills?

[George K]

I doubt they're pills - they're radio-opaque. My guess: He swallowed something. Washers? A fork? Batteries?

[blondie]

You’re right. Something like washers like 21 or so. They’re dark on their insides.

[George K]

Ghali will post the answer tomorrow. It will be interesting. He does a nice narration of what's seen, etc.

[taiwan_girl]

Maybe a bad batch of Cherrio or Fruit Loop?

[Axtremus]

Maybe a string of beads.

[George K]

I have no idea what it it, other than being radio-opaque, probably metallic. Looks like multiple items to me.

Follow up tomorrow, I hope.

[George K]

For some reason the tweet isn’t posting.

Try to paste in a new window..

[Axtremus]

I believe this is the corrected link to the answer:

click to show

Many crayons and a toothbrush.

[George K]

Thanks. What did I do wrong?

[Axtremus]

@George-K said in Today's Medical Mysterie:

Thanks. What did I do wrong?

I'm guessing the author posted the answer, then deleted, and posted another tweet; so the link you posted is no longer valid.

[blondie]

Really? Crayons & a toothbrush?! Well I messed up bad.

[George K]

@blondie said in Today's Medical Mysterie:

Really? Crayons & a toothbrush?! Well I messed up bad.

Yeah, I didn't realize that they were long items. I'm surprised they're radiopaque.

[blondie]

https://appliedradiology.com/articles/what-crayons-look-like-on-ct-and-mr-images Picture C explains the gremlins. I don’t have access to the study, but thank goodness crayons are radiopaque. It’s not uncommon for kids to eat, swallow crayons, or stick them in their noses & ears.

[Axtremus]

I'm amazed that no surgery was needed to extract all those foreign objects.

[George K]

@Axtremus said in Today's Medical Mysterie:

I'm amazed that no surgery was needed to extract all those foreign objects.

Interventional GI medicine has been transformative.

One of the horrors I used to see, early in my career, was the upper GI bleeder. This was usually a patient who had esophageal varices (think varicose veins in the esophagus) due to alcoholic cirrhosis. If one of these veins started to bleed, it was a nightmare.

Similarly, a bleeding stomach ulcer.

With the maturity of upper GI endoscopy, most of these can be treated via an endoscope and some judiciously placed cautery.

That said, snagging a foreign body with an endoscope is not a BFD. Pretty routine, actually.

Looking at the "bottom side," you have to wonder how many pre-cancerous colon polyps were snagged avoiding the need for a colon resection for colon carcinoma. @bachophile probably knows more about this than I do, but toward the end of my career, it seemed like we were doing fewer colon resections than we did in 1980.

Great case, no?

Sam Ghali posts a lot of interesting video on his X feed. Most of them would appeal to medical geeks (funky EKGs, etc). However, I thought this would be fun to share.

[taiwan_girl]

Wow! Interesting. After hearing the answer, I am wondering if stomach acid is strong enough to dissolve wax. I guess not.

[George K]

In the comments: "Had a patient like that in residency except what they ate caused the bowel to perf(orate). Found everything in their peritoneum from pencils to juice box straws."

[bachophile]

I thought also metallic. Maybe there is lead in crayons? Anyway yes colon cancer incidence has been dropping but early onset colon cancer meaning younger than say 50 is on the rise and no one knows why and that why the age for screening colonoscopies which used to be 50 is now dropping to 45 or earlier if u have a family history.