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Gastrointestinal: Heavy stomach

A 54-year-old woman with a history of paranoid schizophrenia and alcohol abuse was brought to the Emergency Department after intentional ingestion of foreign objects for several weeks. She complained of dysphagia and abdominal discomfort for the last week, and physical examination revealed a soft but distended abdomen. Cervical and chest radiographs showed a 47-mm round metal plate in the oropharynx/upper esophagus (Fig. 1), and on plain abdominal film a big, metal-density, gastric bezoar was evident (Fig. 1). On upper endoscopy, we were able to retrieve the metal plate from the epiglottic vallecula (Fig. 2) and to confirm the presence of the metal gastric bezoar consisting of multiple coins, drills, and screws (Fig. 3). Attempts to endoscopically remove the gastric foreign bodies were not performed because of its enormous size. The patient was submitted to open surgical gastrostomy with multiple foreign body removal (Fig. 4), and her recovery was uneventful.