Gastrointestinal 'crosses'. A new shade from an old palette
J. E. Losanoff and K. T. Kjossev
Department of Emergency Surgery, Military Medical Academy, Sofia, Bulgaria.
BACKGROUND: We present our experience with an as yet undescribed type of
intentionally ingested metallic foreign body that was specially designed to
arrest in its passage and cause perforation of the gastrointestinal tract.
The two halves of a standard paper clip are tied crosswise with a rubber
band, forming an elastic "cross." With its branches squeezed to lie
parallel, the cross is wrapped into a small strip of paper and ingested.
After being released from its wrapper, the branches of the cross spring
back to their original position and cause perforation of the bowel wall.
DESIGN: Case series. SETTING: University hospital, Bulgaria. PATIENTS: Five
male prisoners from the same jail undergoing laparotomy for foreign body
removal during 1 week in January 1994. INTERVENTIONS: Laparotomy, removal
of the foreign bodies through incisions of the bowel wall, immediate
restoration of the gastrointestinal tract continuity, and peritoneal lavage
and drainage. OUTCOME MEASURES: Morbidity and mortality. RESULTS: Two of
the patients were initially observed but subsequently underwent surgery for
perforations of the gastrointestinal tract. Three of the patients underwent
immediate operative treatment. There were 20 total crosses ingested; all
foreign objects impacted and perforated the stomach (50%), first duodenal
portion (25%), and fourth duodenal portion (20%). There was no morbidity or
mortality among the five patients treated. CONCLUSIONS: Because ingested
crosses that have been released from their wrappers never move distally,
the only definitive solution is to operate early.
