This crazy diet’s hard to swallow

Surgeons removed more than 100 pieces of metal of various shapes and sizes from the stomach of a man in France, according to a new report of the man’s case.

The 52-year-old had psychosis – meaning he had lost touch with reality – and despite receiving treatment for the condition, he had a tendency to intentionally swallow metal items. These items ranged from nails, knives and screws to spoon handles, nuts and coins, according to the case report published in the journal BMJ Case Reports.

The man ingested the metal objects so frequently that over time, clumps of partially digested or non-digested material would clump together in his stomach in masses known as “bezoars”. These metal bezoars would become so large that they would block the pylorus, the opening connecting the stomach and the small intestine, preventing his stomach from emptying.

Metal bezoars are one of the rarest forms of bezoar, according to the case report. Other types of bezoars include those formed by clumps of undigested milk (seen in infants), hair (in people who ingest hair, a condition known as trichophagia), plant material (from fruit and vegetable fibres) and pills.

In the man’s case, he went to the emergency room five times over a five-year period, complaining of stomach pain, nausea and vomiting up blood. In four of these instances, doctors had to operate to remove a massive metal bezoar from his stomach. Surgery was necessary because removing the metals by endoscopy — a procedure in which a thin, flexible tube is inserted into the stomach from the mouth so that doctors can retrieve the swallowed object — didn’t work, according to the case report.

It was surprising that the man needed surgery on four separate occasions to remove these objects, said Dr Steven Moss, a gastroenterologist and professor of medicine at Warren Alpert School of Medicine of Brown University. Usually, when people swallow sharp metal objects, they can often be taken out safely by endoscopy, Moss said.

Moss was not involved in this man’s case, but he has treated people who have swallowed massive amounts of metal, and was the co-author of a 2010 paper in the journal Clinical Gastroenterology and Hepatology on people who intentionally swallow objects not meant to be swallowed.

During the man’s most recent visit to the emergency room, in December 2016, scans of his abdomen revealed the metal objects had made a hole in his stomach. This meant that, essentially, the stomach had burst, and surgery was the only option to retrieve the swallowed objects, Moss told Live Science.

It may seem unusual that sharp items, such as a swallowed razor blade, could come into contact with the stomach and not cause holes all the time, Moss said. But the stomach has thick walls, and when cuts or scratches happen, the body can be amazingly resilient and heal, he said.

Although the sheer quantity of metal swallowed by the man in this case was “impressive” and “more than normal”, Moss said he has retrieved metal objects ranging from bed springs and batteries to bits of CDs and hundreds of coins.

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