S4026 When Lead Lingers: A Case of Cecal Foreign Body and Concern for Systemic Toxicity

Introduction: We are presenting a case of accidental ingestion of a lead fishing weight, resulting in elevated blood lead levels. The patient underwent successful endoscopic removal of the colonic foreign body made of lead. Case Description/Methods: An 18-year-old man presented to the hospital after accidental ingestion of a fishing weight made of lead. After ingestion of the foreign body, he was self-administering polyethylene glycol bowel preparation, expecting the foreign body to pass. The patient waited a week, but he did notice the foreign body in his stool, so he decided to seek medical attention. He denied abdominal pain, nausea, vomiting or neurological symptoms. On examination, the abdomen was soft, nontender, without organomegaly or ascites. No focal neurological deficits were noted. An X-ray of the abdomen showed a teardrop-shaped metallic foreign body over the right hemipelvis. Computed tomography abdomen and pelvis without intravenous contrast was performed and a 2.5 × 1 cm cylindrical foreign body was seen in the mid to distal jejunum without evidence of bowel obstruction. His blood lead level was elevated at 47 mcg/dL and the local poison control department was contacted. Given the elevated blood lead level, decision was made to perform colonoscopy with endoscopic removal of the foreign body. During colonoscopy the foreign body was identified in the cecum and removed using Roth Net. Blood lead level was rechecked 8 weeks after the removal of the foreign body and was down trending at 23 mcg/dL. He was advised to follow up with his primary care physician for further monitoring of lead levels. Discussion: There are rare cases of lead poisoning due to foreign body ingestions requiring endoscopic removal. Our patient presented one week after accidental ingestion of fishing weight made of lead. Despite the absence of clinical signs of lead toxicity, our patient underwent successful endoscopic removal of the cecal foreign body due to the elevated blood lead level.