Pellets in the Appendix
An 8-year-old hyperactive boy was admitted to the hospital after having been found to have elevated blood lead levels, ranging from 17.4 to 27.4 μg per deciliter (reference range, <10) over a period of 2 years. An abdominal radiograph revealed large numbers of small, hyperdense foci in the right lower quadrant.The entire family reported that they regularly ate geese that were killed with lead pellets from a shotgun, and the children reported that they had been eating the pellets as part of a game to make them disappear. The patient and his siblings underwent bowel washout. A follow-up radiograph of the patient revealed that pellets were still present in the gastrointestinal tract, in either the cecum or the appendix. Laparoscopic appendectomy was performed.The appendix weighed 27.5 g (normal weight, 4 to 5 g), measured 55 mm in length, and had an average external diameter of 7 mm with a wall thickness of 2 mm. A total of 57 lead pellets were recovered from the lumen. Microscopical examination of the appendix showed minor changes with a focus of submucosal calcification and fibrosis. No acute inflammation was observed.
