• M E O'Donnell, N Gibson, M A Sharif, SpenceR A JRA, and J Lee.
• Department of General Surgery, Belfast City Hospital, Lisburn Road, Belfast, BT9 7AB, Northern Ireland, UK. modonnell904@hotmail.com
• Ir J Med Sci. 2008 Dec 1; 177 (4): 401-3.

BackgroundA 29-year-old man was admitted with a 7-day history of progressive non-specific abdominal pain that progressed to small bowel obstruction following ingestion of a 20-pence coin 4-months previously. Colonoscopic retrieval was unsuccessful. A subsequent laparotomy revealed a chronically inflamed thickened terminal ileum with mesenteric fat encroachment necessitating a right hemicolectomy. Histopathological analysis confirmed Crohn's disease with impaction of the 20-pence coin in a distal terminal ileum stricture near the ileo-caecal valve.Learning PointGastrointestinal foreign body retention should alert the clinician to the presence of an undiagnosed bowel abnormality. Furthermore, failed endoscopic retrieval should be considered as a marker for potential underlying gastrointestinal pathology and a requirement for operative intervention.ConclusionThis case describes a rare presentation of Crohn's disease and highlights the need to consider underlying gastrointestinal pathology in patients presenting with a deteriorating clinical condition in the presence of an incidental foreign body.

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