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Needle Ingestion via Halloween Caramel Apples

      To the Editor: Children are often warned to inspect their Halloween candy for foreign objects. However, a review of available studies indicates that the risk of finding such objects in candy may be exaggerated. In 1997, a sociologist from Southern Illinois University reported the results of a literature search on potentially injurious objects placed in candy.
      • United Press International
      Poisoned candy may only be legend.
      The study spanned 4 decades. About 80 cases of sharp objects in food were identified, virtually all of which were hoaxes.
      In contrast to these hoaxes, we report a case of abdominal pain in a middle-aged man who ate caramel-covered apples during the Halloween season. The pain was likely due to ingestion of a foreign body maliciously placed in an apple.

      Report of a Case

      A 55-year-old man with gastroesophageal reflux disease presented to the emergency department because of a 3-week history of worsening epigastric pain. The pain was exacerbated by eating, and the patient denied any associated melena. His vital signs were stable, and slight epigastric tenderness was noted on deep palpation. Esophagogastroduodenoscopy performed 3 days before Halloween for assessment of reflux symptoms revealed only reflux esophagitis. At the current admission 3 weeks later, an abdominal x-ray film showed a slender metallic foreign object in the stomach (Figure 1). Subsequent computed tomography of the abdomen identified an 8-cm-long needle protruding through the posterior wall of the gastric antrum (Figure 2). Esophagogastroduodenoscopy confirmed a sewing needle in the gastric antrum near the prepyloric region (Figure 3), with approximately 6 cm located within the wall of the stomach. The needle was withdrawn endoscopically with an alligator forceps. The patient had no history of surgery and could recall no incident that might account for the presence of the object other than eating several caramel-covered apples on Halloween.
      Figure thumbnail gr1
      Figure 1Abdominal x-ray film showing a needle (arrow) lodged in the stomach.
      Figure thumbnail gr2
      Figure 2Computed tomogram of the abdomen showing a needle (arrow) protruding through the posterior wall of the gastric antrum.
      Figure thumbnail gr3
      Figure 3Endoscopic view of needle (arrow) perforating the gastric antrum.

      Discussion

      Historically, concerns about tampering with apples involved poisons, but in 1967, the focus shifted to the insertion of razor blades and other sharp objects.
      • Santino J
      The razor blade motif spread rapidly in several areas of the eastern seaboard and Canada: The New York Times reported 13 cases from isolated communities in New Jersey and noted several others in Ottawa and Toronto.
      • Santino J
      Outrage was so strong in New Jersey that the state legislature passed a law shortly before Halloween in 1968 that mandated prison terms for those caught inserting hazardous objects into apples. Unfortunately, this effort did not forestall the discovery of 13 more apples with razor blades that year in 5 New Jersey counties.
      • Santino J

      Comment

      This case illustrates the need for physicians to consider the possibility of foreign body ingestion in patients with new-onset gastrointestinal symptoms during Halloween season. Successful and timely intervention can prevent drastic complications, such as intestinal perforation.

      REFERENCES

        • United Press International
        Poisoned candy may only be legend.
        (Accessibility verified August 22, 2003.)
        • Santino J
        Halloween and Other Festivals of Death and Life. University of Tennessee Press, Knoxville, Tenn1994
      1. Pins and needles.
        (Accessibility verified August 22, 2003.)