taining 1500 ml of lukewarm water. The water was administered into the colon through the colostomy by inserting and advancing the irrigation tube as far as he could, and then allowing the water to drain into the colon by gravity. When the irrigation was completed, he attempted to disconnect the irrigation tube from the connecting tube, but noticed that the irrigation tube was missing and was lost in the colon. Attempts to retrieve it by inserting his finger into the colon through the colostomy were unsuccessful. He was asymptomatic and physical examination was normal. A plain x-ray of the abdomen revealed the faint outline of the irrigation tube along the descending and transverse colon. A flexible sigmoidoscopy was performed without any bowel preparation or intravenous sedation. The irrigation tube was located in the descending colon approximately 30 em from the colostomy site. It was retrieved with a diathermy snare and easily removed. There was no injury to the colonic mucosa by the tube. The patient was advised to use the Holiisterâ„¢ cone instead of the irrigation tube to prevent future disappearance of the tube into his colon. Shailesh C. Kadakia, MD Gastroenterology Service Department of Medicine Brooke Army Medical Center San Antonio, Texas 78234

REFERENCES 1. Webb WA. Management offoreign bodies of the upper gastrointestinal tract. Am J Gastroenterol 1988;94:204-16.

2. Nandi P, Dng GB. Foreign body in the esophagus: review of 2394 cases. Br J Surg 1978;65:5-9. 3. Barone JE, Sohn N, Nealon TF. Perforations and foreign bodies of the rectum. Report of 28 cases. Ann Surg 1976;184:601-4. 4. McCanse DE, Kurchin A, Hinshaw JR. Gastrointestinal foreign bodies. Am J Surg 1981;142:335-7. 5. Crass RA, Tranbaugh RF, Kudsk KA, Trunkey DD. Colorectal foreign bodies and perforation. Am J Surg 1981;142:85-8. 6. Schofield PF. Foreign bodies in the rectum: a review. J R Soc Med 1980;73:510-3. The opinions and assertions contained herein are the private views of the authors and are not to be construed as reflecting the reviews of the Department of the Army or the Department of Defense.

Nausea and the snoring spouse

Figure 1. Biopsy forceps approaching foam earplug in hiatal hernia sac.

An esophagogastroduodenoscopy was performed which revealed a 2- to 3-cm cylindrical foreign body (Fig. 1) located within a moderately large hiatal hernia which appeared to have a spongy yellowed end. A disposable snare was used to extract the foreign body which ultimately proved to be a foam earplug. The remainder of the endoscopic examination revealed mild narrowing at the junction of the esophagus and the gastric remnant through which the endoscope easily passed. Upon further questioning the patient stated that she was recently married and began wearing earplugs to cope with her husband's snoring. She denied intentional ingestion. Her husband noted that she had occasional nightmares and also that she would lose earplugs intermittently. They never did an "earplug count." She experienced immediate relief of her symptoms following foreign body extraction and remained symptom free at 3 months. She does have some mild epigastric burning which has been relieved by nizatidine. This case demonstrates a most unusual esophageal foreign body which appears to have caused obstructive symptoms over an extended period in an adult with a previous fundoplication. We hypothesize that the soft earplug acted as a ball-valve device in the distal aspect of the hiatal hernia with resultant intermittent obstruction. We are not aware of prior reports of similar esophageal obstruction which was both chronic and without dysphagia. This case suggests a true medical complication of a snoring spouse. Nathan Markowitz, MD University of Utah Wasatch Clinics Salt Lake City, Utah

To the Editor: A multitude of objects have been described as esophageal foreign bodies. We report the first case of an inadvertently swallowed foam earplug with resultant obstructive symptoms in a patient with a previous fundoplication. A 46-year-old woman presented with progressive nausea and vomiting of 4 months' duration. Previous medical management included a trial of H2 blockers without success. Her symptoms consisted of vomiting any food that she had eaten, including liquids, within 5 to 30 min of eating. The vomitus consisted of only recently eaten food. She was able to consume only small amounts of solid cereals. She denied any significant weight loss or dysphagia. Her medical history was significant for fundoplication and a gastric stapling 4 years ago which cured her heartburn symptoms and permitted her to lose 100 lb. 734

Early diagnosis of colon cancer due to Citrullus vulgaris To the Editor: The hazard of intestinal obstruction associated with the ingestion of fruit seeds has been well documented. 1- 3 However, there is a paucity of reports detailing any virtue associated with such seed ingestion. We recently cared for a 62-year-old man who presented with symptoms of intermittent abdominal distention and discomfort, associated with bouts of emesis and obstipation of a few weeks duration. His past medical history was GASTROINTESTINAL ENDOSCOPY

Nausea and the snoring spouse.

taining 1500 ml of lukewarm water. The water was administered into the colon through the colostomy by inserting and advancing the irrigation tube as f...
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