Endoscopic management of a nail-magnet aggregation impacted in the terminal ileum: a case report

Management of inedible foreign objects within the gastrointestinal tract requires diligent observation and timely intervention in situations of impaction, obstruction or perforation. Here, we describe an adult patient with borderline personality disorder presenting with sequential ingestions of nails and magnets that had already passed beyond the reach of upper endoscopy. These objects conglomerated as a single mass in the terminal ileum and failed to clear into the colon despite a prolonged trial of conservative management. The patient underwent a successful colonoscopy to remove a significant component of the bezoar, allowing the remaining objects to pass through the ileocecal valve and be eliminated. This case highlights the benefits of careful conservative management with prudent use of endoscopy to manage impaction of foreign bodies in the terminal ileum in an otherwise stable adult patient.