Porcelain spoon broken and swallowed during convulsion.

To the Editor—It is common but erroneous practice among the general public to insert an object into the patient’s mouth during a convulsion to prevent him or her from biting the tongue or lips. This can actually cause more harm than good. Using a metal object, such as a spoon, may cause injury to the mouth or result in broken teeth, while objects like pencils or sticks may be bitten into pieces and become lodged in the airway. We describe an 18-year-old young man with known epilepsy who presented to us in August 2007 with odynophagia after an episode of convulsion. The patient’s father inserted a porcelain spoon into his mouth during the convulsion in an attempt to ‘protect’ the tongue. The spoon was bitten into pieces, causing lacerations to the buccal mucosa, and the father later found that broken pieces of the spoon were missing. Plain radiographs of the neck, chest, and upper abdomen failed to identify any ingested foreign body. Oesophagogastroduodenoscopy was performed within 1 hour of admission. Three broken pieces of the porcelain spoon were seen within the stomach (Fig), and these were retrieved using a dormia basket and removed through an oesophageal over-tube. The patient remained well afterwards, and was discharged 3 days later. This case serves to remind physicians looking after epileptic patients to educate the patients’ family members not to insert objects into their mouths during convulsions. In this instance, swallowing broken pieces of the porcelain spoon could have caused life-threatening perforation of the gastro-intestinal tract. Vincent KS Leung, FRCP, FHKAM (Medicine) E-mail: [email protected] Department of Medicine and Geriatrics United Christian Hospital Kwun Tong Hong Kong Porcelain spoon broken and swallowed during convulsion L E T T E R T O T H E E D I T O R