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Doctors used cap-assisted colonoscopy to remove eight nails from a woman in her 30s after they lodged near the ileocecal valve. The case report describes only minor superficial abrasions, but the authors caution that the technique carries risks and should be performed by experienced endoscopists with surgical backup available.
Doctors removed eight nails from the colon of a woman in her 30s using a cap-assisted colonoscopy after the objects lodged near the ileocecal valve and did not pass during four days of observation. The case, reported in BMJ Case Reports, describes only minor superficial abrasions after removal, while its authors warn that the method carries a risk of perforation and requires an experienced endoscopist and surgical backup.
The patient, who was receiving psychiatric care and had a history of intentional foreign-body ingestion, came to hospital with persistent abdominal pain after swallowing multiple nails. It was her sixth episode in the previous year, according to the case report. Doctors initially chose conservative management: bowel rest, polyethylene glycol therapy and abdominal X-rays every 12 hours to track the objects.
Imaging showed that the nails moved from the middle of the abdomen to the right lower quadrant, where they gathered near the ileocecal valve, the junction between the small and large intestines. After four days without passage, the team performed colonoscopy. Using a snare, the doctors retrieved all eight nails, taking care to position their sharp ends beneath a hard, transparent cap attached to the end of the scope. A post-procedure examination found minor superficial abrasions to the colon lining.
The report says the psychiatry department was consulted and recommended admission, but the patient refused. At one-year follow-up, the authors reported no further complications from the colonoscopy and said she was being followed as an outpatient. The case does not establish that the technique is suitable for every patient or every sharp object in the lower gastrointestinal tract.
A Possible Option for Sharp Objects
Sharp swallowed objects can injure or perforate the digestive tract, and nails can be particularly difficult to grasp because of their irregular shape. This case shows one way a specialist team removed objects that had reached the colon, potentially avoiding an operation for this patient. It is a single case report, however, not evidence from a large study that the approach is broadly safe or effective.
The authors say cap-assisted colonoscopy may be useful for clinically stable patients without signs of perforation or peritonitis, provided surgical backup is readily available. That qualification matters: the procedure itself can cause injury, and the authors warn that perforation is a significant risk both before and during removal. Decisions about observation, endoscopy or surgery depend on the patient’s condition and the objects’ location.
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How the Nails Reached the Colon
Many swallowed foreign objects pass through the digestive tract without an intervention. The authors cite an estimate that about 80% pass spontaneously, while noting that endoscopic retrieval may be considered when conservative management fails or when sharp objects pose a risk of perforation. The estimate is general background from the case report, not a prediction for this patient’s outcome.
At first, the clinical team considered the nails too far along for safe endoscopic removal and monitored their movement with repeated X-rays. Their eventual location near the ileocecal valve allowed the team to attempt colonoscopy after they had not passed. The cap used in the procedure is a short polymer tube fitted to the scope’s tip; in this case, it helped shield the colon lining as the nails were grasped and withdrawn.
Reports of lower-GI foreign-body retrieval are limited, according to the authors. Bhoowit Lerttiendamrong, a University of Connecticut School of Medicine physician who discussed the case with MedPage Today, said that objects reaching the lower digestive tract—and especially sharp ones—are uncommon. He also said there is no established guideline for managing cases like this.
““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 cannot show how often cap-assisted colonoscopy succeeds or how its risks compare with surgery or continued observation. The authors identify technical limitations: advancing a scope with a cap can be difficult in a tortuous or challenging colon, and the cap itself may cause trauma even as it protects the lining from a sharp object. They also say there are no established guidelines for cases like this.
The patient’s refusal of the recommended psychiatric admission is recorded, but the report does not provide further detail about the reasons for her decision or subsequent psychiatric care. It says she remained in outpatient follow-up and had no colonoscopy-related complications at one year. The material does not describe her longer-term course beyond that point.
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Specialist Care and Follow-Up
The case report does not announce a planned trial or change to clinical guidelines. For now, its practical message is limited: doctors considering removal of sharp objects from the colon must weigh the risks of waiting, endoscopy and surgery for each patient. The authors say cap-assisted colonoscopy should be considered only in suitable, clinically stable cases, performed by experienced endoscopists with surgical backup available.
The patient was being followed as an outpatient, and the authors reported no further complications one year after the procedure. Whether the technique should be used more widely remains unsettled; additional reports or research would be needed to clarify its safety, appropriate patient selection and role alongside other treatment options.
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Key Questions
How many nails did doctors remove?
The doctors retrieved all eight nails during cap-assisted colonoscopy, using a snare and taking care to keep the sharp ends beneath the cap.
Where were the nails lodged?
Imaging showed the nails clustered near the ileocecal valve, where the small intestine joins the large intestine.
Did the procedure injure the patient?
The report describes minor superficial abrasions to the colon lining after removal. The authors reported no further complications from the colonoscopy at one-year follow-up.
Is cap-assisted colonoscopy an established treatment for swallowed nails?
The case report does not establish it as a standard treatment. The authors say there is no established guideline for cases like this and caution that the procedure has limitations and a significant perforation risk.
What safeguards did the authors recommend?
They said the technique should be used only for appropriate, clinically stable patients, by experienced endoscopists, with surgical backup readily available.
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