Multiple lead appendoliths following ingestion of lead shot: time course and removal by laporoscopic appendectomy

Systemic lead poisoning may occur from ingested lead foreign bodies. Rarely, these may cause a retained appendolith. The risks of lead toxicity from these appendoliths, the time course of retention in the appendix, the rapidity of inhibition of heme synthesis, and the best approach to removal remain controversial. Fourteen days post-ingestion of a "handful" of lead shot, a 15-year-old male was admitted for elevated lead level; an x-ray showed aggregation of many pellets in the teen's appendix. A laparoscopic appendectomy was performed; examination of the removed appendix revealed greater than 50 retained pellets. An abdominal film obtained post-procedure showed removal of all but three of the pellets. Results from admission blood work found a blood lead level of 41 mcg/dL and free erythrocyte porphyrin (FEP) level of 114 μmol/mol heme (reference normal <70). After a short recovery the patient was discharged on succimer chelation therapy and on follow up, his lead level was <5 mcg/dL.