FROM coins to dentures, some of the things that people have swallowed would put the most extreme eating challenges on the TV series Fear Factor to shame.

One of the items that made headlines recently was a $2,700 diamond ring, complete with price tag.

Odd-job worker Mohamad Azman Abdullah, 48, was jailed 1 1/2 years earlier this month for stealing the ring, and a subsequent Straits Times report delved into the stomach-churning details.

Azman had swallowed the ring while shopping in a jewellery store. Police who nabbed him took him to hospital where X-ray scans showed the ring of white gold with the diamond embedded, lodged in the base of his stomach.

Later, as policemen kept an eye on the sedated patient, a trainee surgeon fished it out in five minutes using an endoscope - a long, thin and flexible tube with a camera and a pair of forceps at the end. This was inserted into Azman's stomach through his mouth. As it turned out, the price tag provided a handy grip for the forceps.

Gem-gulping thieves aside, doctors say the main concern when a patient, usually a hapless child, swallows a foreign object, is its shape and size.

The object first passes through the oesophagus (food-pipe) and into the stomach. This is where endoscopy can be done, if the problem is discovered early.

But once the object goes into the small intestine and on into the large intestine, it becomes too difficult to insert an endoscope. However, chances are that it can be passed out naturally 80 to 90 per cent of the time.

That is provided growths or cancers do not obstruct the passageway, says gastroenterologist Dr Ang Tiing Leong from Changi General Hospital.

Less than 1 per cent of cases require surgery, usually due to complications such as intestinal wall damage if the object is sharp. Also, if it is too big, 'to pull it back up may cause damage along the way', says Dr Yap Chin Kong, a gastroenterologist at Mount Elizabeth Medical Centre.

About 90 per cent of patients swallowing objects are children, say doctors. Last year, KK Women's and Children's Hospital reported 349 such emergency cases. Paediatrician Dr Arif Tyebally explains: 'Babies and young children learn about their world by putting things in their mouths.'

Doctors advise that if you have children roaming about, check your floors periodically for coins, buttons, jewellery, small toys, pins and other small objects and keep them out of reach of children. Also, ensure the toys they play with are safe and don't have small parts that can come loose.

Cases for adults are more rare and often involve the elderly or the mentally retarded. Symptoms include signs of discomfort such as nausea, bloating, pain and vomiting.

If someone has swallowed an inedible object, gastroenterologist Dr Tan Chi Chiu from Gleneagles Medical Centre advises: 'Go and seek medical advice. X-ray scans will probably need to be done to see where the object is. Then a decision will need to be taken on what to do about it.'

Safe but don't try

THE most common objects encountered are coins, buttons, beads and toy parts. Stomach acids are not strong enough to react with such objects and break them down. However, because they are small, smooth and blunt, they can be passed out naturally in the stool without any complications.

This can take from two to three days, but Dr Yap from Mount Elizabeth also points out that sometimes it can take up to a week, depending on the person's intestinal contractions.

Dangerous...

A SAFETY pin is definitely not safe to have in your tummy. It can cause damage anywhere along the digestive tract. 'It can cause cuts and patients may develop complications,' says gastroenterologist Dr Law Ngai Moh from Raffles Hospital.

Usually such objects should be extracted as soon as possible.

Minor lacerations can be treated with antibiotics, and the body heals itself, but if the cuts are serious, severe infection and pus may develop, according to Dr Law. In such cases, surgery is needed.

Other oddities ingested: Mount Elizabeth's Dr Yap says he has treated a man who bit off the tip of a satay stick by accident, and swallowed it. It caused minor cuts but was removed from his stomach by endoscopy.

Button batteries, which are often found in kids' toys, are dangerous even though they are blunt, as they contain chemicals that can leak and cause severe burns and poisoning, says gastroenterologist Dr Lim Lee Guan from the National University Hospital.

There are also cases of smugglers swallowing drugs wrapped in plastic bags or inside condoms, hoping to pass out the packets naturally later. Doctors say this is highly risky as a drug overdose is bound to occur if the packet breaks or leaks.

Bizarre

DR YAP from Mount Elizabeth recalls a case where an elderly woman patient swallowed her dentures by accident. 'She was popping food in her mouth and she hit her dentures with her finger, dislodging them, and they got swallowed,' he says.

The dentures got stuck in her throat, causing severe pain. They were removed by endoscopy. On rare occasions, doctors have had to treat patients who have swallowed keys and even a broken toothbrush. Some such patients are mentally disturbed or retarded.

Gleneagles' Dr Tan says he came across a case where a mercury thermometer was actually chewed and swallowed by a patient with psychiatric problems. The glass shards were endoscopically removed with great care.

The mercury, although poisonous, was inert and was not absorbed by the digestive system. It eventually passed out naturally as a liquid.

This article was first published in The Sunday Times on Mar 16, 2008.