From Childhood Ingestion to Adult Obstruction: A Long-Retained Synthetic Gastric Foreign Body

Foreign body ingestion occurs predominantly in children, and most objects pass spontaneously; only a minority require endoscopic or surgical intervention. Prolonged gastric retention of synthetic material with presentation in adulthood is exceptionally uncommon. A 26-year-old man, who recalled accidental ingestion of expanding construction foam at four to five years of age, was first evaluated by gastroenterology on initial presentation for long-standing epigastric pain, nocturnal discomfort, heartburn, acid regurgitation, reduced appetite, and intermittent vomiting. He had no significant recent weight loss and had always been slender (body mass index: 19 kg/m²). Esophagogastroduodenoscopy revealed a 2-cm angular ulcer, two smaller corpus ulcers, and a large green-black intragastric mass whose food-like appearance led it to be initially interpreted as undigested retained food. Gastric biopsies demonstrated chronic inflammatory and fibrotic changes, intestinal metaplasia, and moderate-to-severe epithelial dysplasia without invasive malignancy. The approximately 4-cm hard, presumed polyurethane-based plastobezoar resisted four endoscopic extraction procedures because it could neither be safely withdrawn through the gastroesophageal junction nor adequately fragmented with available devices. After the final attempt, it migrated into the ileum and produced acute mechanical small bowel obstruction. Open exploration identified the foreign body approximately 70 cm proximal to the ileocecal valve. It was removed through enterotomy without bowel resection because the intestine was viable. The operation lasted 50 minutes; oral intake resumed on postoperative day two, and the patient was discharged on postoperative day seven. Follow-up endoscopy approximately five months later showed only a small angular scar. Surveillance biopsies demonstrated chronic inactive gastritis with focal glandular atrophy and resolution of the previously observed dysplasia, with no ulceration or residual dysplasia. This case highlights the diagnostic difficulty of radiolucent synthetic material, the consequences of prolonged retention, and the need for timely transition to surgery when a large, noncompressible object cannot be safely removed endoscopically.