Infantile Perianal Pyramidal Protrusion

For several months, a 52-year-old woman had nausea, mild dysphagia with solid food, vague abdominal pain, and diarrhea. The patient denied hemoptysis, hematochezia, and melena. Lansoprazole and dicyclomine provided minimal relief of her symptoms.

Her medical history included a dilated esophageal stricture, hiatal hernia, spastic colon, hypertension, and well-controlled type 2 diabetes mellitus. The family history was significant for irritable bowel syndrome and colon cancer.

Drs Firaz Hosein and David Cohen of the Miami Heart Institute noted mild epigastric tenderness on examination. Laboratory data, including amylase and lipase levels and liver function test results, were within normal limits. A colonoscopy revealed a 1.5-cm metal screw in the ascending colon (A); no other abnormalities were noted. The screw was removed from the colon (B) during colonoscopy without any damage to the luminal wall. An upper GI tract endoscopic examination showed normal esophageal mucosa, hiatal hernia, gastritis, and duodenal bulb inflammation. Antral biopsies were negative for Helicobacter pylori.

The patient, who does not wear dentures, apparently did not realize she had swallowed the screw! She was counseled on cutting and chewing her food properly before swallowing. The mild dysphagia may have been secondary to a nonspecific motility disorder associated with gastroesophageal reflux disease.

No changes were made in her drug regimen; a gastric emptying study is scheduled. If the symptoms persist, manometry will be performed.

The origin of the screw was never determined.