TL;DR
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Doctors used cap-assisted colonoscopy to remove eight nails from a woman in her 30s after imaging showed they had clustered near the ileocecal valve and had not passed after four days of conservative care. The case report says the procedure caused only minor superficial abrasions; the authors caution that it carries a significant perforation risk and requires experienced endoscopists and surgical backup.
The patient came to hospital with persistent abdominal pain after intentionally swallowing multiple nails. She had a history of pica, anxiety and repeated foreign-body ingestion; this was her sixth such episode in a year, the case authors wrote. The report does not identify her.
Doctors initially monitored her with abdominal X-rays every 12 hours, bowel rest and 3 liters of polyethylene glycol, a laxative solution. Imaging showed the nails move from the middle of the abdomen to the right lower quadrant, where they clustered near the ileocecal valve, the junction between the small and large intestines. After four days without passage, the team proceeded with colonoscopy.
Using a snare, the doctors removed all eight nails, taking care to keep their sharp ends beneath a hard, transparent cap fitted to the colonoscope. The authors reported minor superficial abrasions on inspection of the colon lining. Psychiatry was consulted and recommended admission, but the patient refused. At one-year follow-up, she had experienced no further complications from the colonoscopy and was being followed as an outpatient.
A Rare Lower-GI Retrieval
The report describes an uncommon situation: sharp objects reaching the lower gastrointestinal tract and being removed endoscopically from the colon. Nails can be difficult to grasp because of their irregular shape and sharp edges, which may injure tissue or make surgical intervention necessary.
The case adds to a small number of reports on retrieving foreign objects from the lower GI tract. It offers clinicians an example of how a protective cap may help shield the colon lining during removal, but it is one successful case, not evidence that the approach is suitable for every patient or setting.
The authors say the method may be considered for clinically stable patients without signs of perforation or peritonitis, if surgical backup is readily available. Those conditions matter because a sharp object can cause serious injury before or during removal.
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Four Days of Monitoring
The patient’s nails were initially considered too far along for safe endoscopic removal, so the team chose conservative monitoring with serial imaging and bowel preparation. When follow-up X-rays showed the objects had gathered near the ileocecal valve and none had passed after four days, doctors reassessed the plan.
The case report notes that about 80% of swallowed foreign objects pass on their own. The authors say endoscopic retrieval should be considered when conservative management does not work or when sharp objects pose a risk of perforation. That general estimate does not establish what would happen in an individual case.
Cap-assisted endoscopy uses a short polymer tube on the tip of a scope. The authors describe the cap as a way to reduce blind spots during colonoscopy and to help protect the lining during removal. The team used it here to cover the nails’ sharp ends as they were drawn out.
““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, University of Connecticut School of Medicine, speaking to MedPage Today
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Limits and Risks Remain
The report does not establish how often cap-assisted colonoscopy succeeds for sharp objects in the colon, or how its risks compare with other approaches. The authors describe the technique as not widely proven, and note there is no specific guideline for cases like this.
They also identify technical limits: advancing a scope with a cap can be difficult in a tortuous colon, and the cap itself may cause trauma even as it shields tissue from the object. The report does not give a broader outcome rate or show whether the same result would be expected in patients with different clinical findings.
The patient declined the psychiatric team’s recommendation for admission. The case account says she was followed as an outpatient, but does not provide further detail about her psychiatric care or subsequent follow-up beyond the absence of colonoscopy complications at one year.
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Follow-up and Clinical Use
The patient was being followed on an outpatient basis, and the report records no further complications one year after the procedure. It does not describe a planned additional intervention or a change to clinical guidelines.
For similar cases, the authors’ stated conditions are that the patient be clinically stable, show no evidence of perforation or peritonitis, and have experienced endoscopists and surgical backup available. Whether the approach is appropriate in a particular case depends on clinical assessment; the report does not offer a universal protocol.
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Key Questions
How many nails did doctors remove?
The case report says doctors removed all eight nails using a snare during colonoscopy.
Where were the nails lodged?
Imaging showed the nails clustered near the ileocecal valve, where the small intestine meets the large intestine.
How did the team protect the colon during removal?
Doctors fitted a hard, transparent cap to the end of the colonoscope and kept the nails’ sharp ends beneath it while removing them. The report says the colon lining had minor superficial abrasions afterward.
Was the procedure risk-free?
No. The authors warn that perforation is a significant risk before and during the procedure. They say the technique should be performed by experienced endoscopists, with surgical backup readily available.
What happened to the patient afterward?
The patient declined a recommendation for hospital admission and was followed as an outpatient. The report says she had no further complications from the colonoscopy at one year.
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