By Dr. Anthony Policastro

Last week I talked about neurological zebras. Zebras are rare diagnoses that you never expect to find. However, sometimes you do. Another type of zebra that I have seen over the years has been the foreign body type. I have seen a number of these as well.

Sometimes the history is helpful in making the diagnosis. I had an adolescent female come to the ER one day when I was a pediatric resident. Her complaint was that whenever she burped, it smelled like rotten eggs. While we were talking, she burped. It indeed smelled like rotten eggs.

So we took a history. That history included a dietary history. It appears she was fond of eating oranges. That was not too unusual. However, she didn’t bother peeling them. She would eat them orange peel and all.

Orange peels are not digestible by stomach acid. She wound up with a collection of orange peels in her stomach. The name for that is phytobezoar (there’s your word for the week.) They had to remove it by endoscopy.

At other times, the history is not always given completely. We had an 8 year old boy come into the ER again when I was a pediatric resident. He was complaining about a feeling that there was something stuck in his swallowing passageway.

We again took a history. However, there was nothing that would suggest a cause. We did a chest X-ray. There stuck in his upper esophagus was a toy jack. We went back to tell him that. At that point he confessed that he was throwing jacks up in the air and catching them in his mouth. He clearly was not very good at catching them in his mouth only.

I one time had a 15 year old boy admitted to the hospital. This also happened when I was a pediatric resident, I guess my hospital attracted them. He was admitted because he had blood in his urine.

Again we took a history. Again there was nothing in the history that would suggest a cause for him having blood in his urine. So once again we did an X-ray. His abdominal X-ray showed a long Bic pen in his bladder. He had neglected to tell us that he had lost it while doing self stimulation.

When I was an attending physician at Andrews AFB, we had a toddler admitted for some urinary studies. Before they did the study, they did an X-ray of her abdomen to make sure everything looked as expected.

It did not. The X-ray showed a straight pin located in her abdomen. It appeared to be in the small intestine. It had to be surgically removed. They performed surgery, they started looking at the small intestine from one end to the other. They began at the upper end just past the stomach. They ended at the other end just before the large intestine. Nothing was there.

So they went back up the other way again to the stomach. Again nothing was there. They decided to look beyond the small intestine. They found the straight pin sitting in her appendix. I was able to publish an article about her Ap“pin”dectomy.

When you hear hoofbeats, think of horses. But, every now and then a zebra shows up.