Surgeons Extract 13 Pens, Five Spoons, and Candle From Patient's Stomach

Surgical teams successfully removed 13 full-sized pens, five metal spoons, and a wax candle from a female patient's stomach during an emergency gastrotomy. The rare case highlights extreme manifestations of foreign body ingestion, a clinical emergency driven by severe psychiatric compulsions such as Pica, requiring immediate surgical removal to prevent lethal gastrointestinal perforation.

The Surgical Extraction and Physical Realities of Gastrointestinal Obstruction

When the surgical team opened the gastric cavity during the emergency procedure, they confronted an unprecedented sight: a dense cluster of dense stationary objects filling the gastric lumen. The patient had swallowed 13 individual writing pens, five full-sized cutlery spoons, and a solid wax candle. The lead surgeon noted that while small accidental ingestions occur periodically in clinical settings, seeing a human pharynx accommodate an object as long and rigid as a heavy marker pen—multiple times over—represents an extreme physiological anomaly.

Under normal anatomical conditions, swallowing a rigid object exceeding five centimeters in length triggers violent pharyngeal gag reflexes and esophageal spasms. To push 13 separate pens and five metal utensils down the esophagus requires overriding the body's primary protective airway reflexes. Once these items traverse the lower esophageal sphincter, they settle in the stomach's dependent fundus or body. Because the human pylorus—the muscular valve controlling exit into the duodenum—measures less than two centimeters in diameter, rigid objects like spoons and full-length pens become permanently trapped inside the gastric reservoir.

Hydrochloric acid inside the stomach maintains a pH between 1.5 and 3.5. While powerful enough to break down tough proteins, gastric acid cannot dissolve polypropelene plastics, stainless steel utensils, or dense paraffin wax. Instead, the persistent mechanical grinding of the stomach's muscular walls (peristalsis) squeezes these sharp, rigid foreign bodies directly against the delicate mucosal lining. Over time, this constant abrasion causes pressure necrosis, severe internal hemorrhaging, and eventual full-thickness perforation into the peritoneal cavity.

Understanding Pica and Compulsory Foreign Body Ingestion

The intentional consumption of non-nutritive, non-food substances is clinically classified as Pica, a complex psychiatric disorder. While mild Pica in young children or pregnant women sometimes manifests as cravings for clay, ice, or chalk—often tied to severe iron or zinc deficiencies—the ingestion of large manufactured hardware represents a far more severe psychiatric emergency. Clinical literature links compulsive ingestion of sharp or massive hardware to profound psychiatric conditions, including schizophrenia, severe developmental disorders, major depressive episodes, and clinical borderland states.

In extreme presentations, patients experience acute sensory distortion or powerful compulsive urges that override pain signals and gag responses. The presence of a wax candle alongside metallic cutlery and plastic pens suggests repeated episodes of unobserved ingestion over an extended timeframe. Paraffin wax, while non-toxic in small quantities, creates an impermeable mass when mixed with dense cutlery, completely blocking normal digestion and causing rapid gastric distension.

Patients suffering from chronic foreign body ingestion frequently hide their behavior due to cognitive disorientation or profound guilt. Consequently, diagnosis rarely occurs at the moment of swallowing. Instead, medical intervention becomes unavoidable only when the patient develops toxic symptoms: relentless localized abdominal pain, intractable bilious vomiting, persistent internal bleeding, or septic shock caused by intestinal rupture.

Clinical Protocols for Retrieving Ingested Foreign Objects

Managing gastrointestinal foreign bodies depends entirely on the size, shape, and composition of the swallowed items. Medical practitioners typically deploy flexible upper endoscopy for smaller, smooth items. Under conscious sedation or general anesthesia, an endoscope equipped with specialized snare forceps or retrieval nets enters through the mouth to capture and extract the item. However, endoscopic retrieval becomes clinically impossible when dealing with high-volume, sharp, or tightly impacted items.

Attempts to pull 13 full-length pens and five metal spoons back through the narrow lower esophageal sphincter and vocal cords using endoscopic tools carry an unacceptably high risk of tearing the esophageal wall or suffocating the patient. In this case, an open laparotomy and gastrotomy proved to be the only viable life-saving choice. Surgeons make a surgical incision through the anterior abdominal wall, locate the stomach, and execute a precise incision directly into the gastric body to manually remove the accumulated hardware.

Following physical removal and closure of the gastric wall, patient recovery requires strict dual-track management. Beyond monitoring post-operative risks such as suture leaks, peritonitis, or abdominal wound infections, long-term success relies entirely on psychiatric stabilization. Without intensive psychiatric intervention, behavioral management, and continuous environmental monitoring, recurrence rates among Pica patients remain extraordinarily high, often resulting in repeated life-threatening surgical emergencies.

Frequently Asked Questions

How can full-sized objects like pens and spoons pass through the esophagus?

The human esophagus can dilate under persistent compulsive forcing during severe psychiatric episodes despite intense gag reflexes. However, large items above five centimeters become trapped inside the stomach cavity, unable to pass through the pyloric sphincter.

What is Pica syndrome and why does it lead to eating non-food items?

Pica is a psychological disorder characterized by an uncontrollable craving to consume non-nutritive substances like plastic, metal, or dirt. It is frequently associated with severe psychiatric conditions, developmental disorders, or severe mineral deficiencies.

What medical risks arise when solid metal and plastic objects remain in the stomach?

Trapped non-digestible objects cause gastric wall ulceration, internal bleeding, and irreversible tissue necrosis. If left untreated, these items puncture the gastrointestinal tract, causing peritonitis and fatal systemic sepsis.