A case of an ingested sewing needle in the appendix

 CommentaryThere is not a place in the GI tract, be it in hollow or solid viscera, that sewing needles have not migrated to and lodged after ingestion; they even have been found outside of the GI tract in the aorta and heart. The first case of acute appendicitis caused by a swallowed needle was reported in 1912 by William Eames. The needle in this case, however, is not a sewing needle of which there are many types that differ in length, point, and eye design, but rather a hemming pin. The characteristic head of the hemming pin potentially makes it easier to remove this pin from the GI tract because the head lends itself to being caught in a snare. Alas, in this case, because of the “tortuosity” of the appendix, no such grasping was possible. Appendiceal tortuosity tends to be found in younger people, such as the tailor, who is the subject of this report, because with advancing age, the appendix involutes and becomes narrower. I have seen appendices in the elderly, however, that have extended across the abdomen to wrap around the sigmoid and cause colon obstruction, so this anatomic fact may lead one diagnostically astray. Appendiceal foreign bodies are rare but myriad, ranging from the most common (ie, pins and bird shot) to the exceptional (eg, a die, dental crown, thermometer, and even a condom). The most important point for the treating physician is that foreign bodies that lodge in the appendix are prone to perforate and inflame, and therefore should be removed; most patients with foreign bodies in the appendix are or will be symptomatic. The most important point for this particular tailor: keep all pins out of your mouth and store them until needed in a pin cushion that you keep close by.Lawrence J. Brandt, MDAssociate Editor for Focal Points

PII: S0016-5107(09)02231-7

doi:10.1016/j.gie.2009.07.014

© 2009 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.