Gastrointestinal "crosses" - An indication for surgery

Background: We present our experience with a unique type of foreign body th at was, specifically designed to arrest in its passage and cause perforatio n of the gastrointestinal tract. Study: Between 1994 and 1999, nine male pr isoners from the same jail presented after ingestion of "crosses." A cross is constructed from the two halves of a standard paperclip that are tied to gether with a rubber band. The resulting construction is elastic: the two b ranches can be pulled to lie parallel, but they assume their original posit ion once released. The cross, is wrapped into paper with its branches paral lel and ingested. After release from the Wrapper, it "opens" and causes bow el perforations. Results: All patients underwent emergency surgery for fore ign body removal and treatment of peritonitis. A total of 19 crosses were r emoved from the patients. Six (32%) were found in the stomach; five, in the duodenum (28%); three, in the jejunum and ileum (16%); and one, in the pyl orus and colon. There was no morbidity or mortality. Conclusions: Foreign b odies of this type never pass distally. The ultimate key to success in the management of patients who have ingested crosses is emergency surgical inte rvention.