Background: Accidental ingestion of sharp metallic objects in children can lead to mucosal injury, penetration, or perforation. Management depends on the object’s location, symptom severity, and progression on serial imaging.
Case Presentation: A 4-year-old boy presented with painful defecation and non-bloody stools. Caregiver history indicated ingestion of a sharp metal pin from a hairbrush about two weeks prior. Vital signs were stable, and no signs of peritonitis were observed. Plain radiography revealed a sharp radiopaque foreign body in the pelvis. A rectosigmoidoscopy without bowel preparation did not visualize the object. The patient was closely monitored with serial examinations and radiographs. As the foreign body did not pass and remained fixed on imaging, abdominopelvic computed tomography (CT) was performed, showing a metallic-density foreign body adjacent to the distal rectum with surrounding edema/stranding, raising concern for possible penetration. The patient underwent exploratory laparotomy, and the pin was removed from the rectum with extension into surrounding pelvic tissue. He recovered without documented complications.
Conclusion: A sharp metallic foreign body with a fixed location on serial imaging, especially in a symptomatic child, should prompt early escalation to cross-sectional imaging and surgical consultation to prevent delayed penetration or perforation.