Journal of Education and Teaching in Emergency Medicine

Treating foreign body ingestion in the emergency department (ED) is common; however, certain ingestions may be immediately life-threatening, depending on the object because sharp objects pose the greatest risk for gastrointestinal injury, including perforation and obstruction.1 This is a case of an adult male who arrived at the ED with suicidal ideation and reported ingesting a pencil two days prior. He presented with abdominal pain and hematochezia. A computed tomography (CT) scan of the abdomen and pelvis identified the pencil in the distal ileum. The patient was admitted for surgical evaluation and monitoring. Remarkably, the pencil was passed spontaneously in the stool on hospital day six without signs of colonic perforation. This case illustrates how selected cases of high-risk foreign body ingestion may be managed conservatively, though close monitoring is critical given the risks of perforation, obstruction, or failure of progression.