Successful Endoscopic Removal of an Ingested Thumbtack Stuck in the Ileocecal Valve in a Patient With a Psychiatric Disorder

Foreign body ingestion is sometimes missed during the initial evaluation of a patient with a psychiatric disorder in the emergency department. This is often due to a lack of awareness regarding the need for thorough physical and diagnostic imaging examinations. Additionally, the management of ingested foreign bodies is often controversial. It is essential to consider the risk of complications, especially with sharp objects in luminal organs, necessitating a cautious and attentive approach to the extraction strategy. A 20-year-old woman with autism spectrum disorder was brought to the emergency department after being found collapsed. Her consciousness improved upon arrival, and no abnormalities were noted except for mild epigastric tenderness. Based on her regular physical examination, blood tests, and electrocardiogram, the syncopal episode was attributed to psychological factors. However, the patient's mother provided critical information about missing thumbtacks from the patient's belongings and mentioned prior episodes of thumbtack ingestion. This information underscored the value of obtaining comprehensive patient history in forming an accurate diagnosis. Imaging studies revealed two thumbtacks in the duodenum and small intestine without signs of free air. Conservative management was chosen, and one thumbtack was naturally excreted on the fifth day, while the other remained stuck in the terminal ileum. A subsequent colonoscopy showed the tip of the thumbtack in the ileocecal valve's lumen, which was successfully removed with forceps without complication. Endoscopic removal of foreign bodies, being noninvasive, should be the first choice as long as it can reach the target. This technique minimizes patient discomfort and recovery time, instilling confidence in the medical team's management strategy. Furthermore, patients with mental health disorders or dementia, even when specific symptoms are absent, should be regarded as potentially at risk for incidental or unrelated medical conditions. Emergency physicians must maintain a high index of suspicion during initial evaluations. Gathering a comprehensive medical history, including prior behavioral patterns and habitual tendencies, is essential for accurate assessment and management.