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A 73-year-old Inuit woman was referred for a barium enema after an incomplete colonoscopy. A preliminary abdominal radiograph showed that the appendix was completely full of lead shot, with the contour of the appendix easily visualized. The natives of northern and western Alaska hunt waterfowl in the spring and fall and often inadvertently swallow some of the lead shot embedded in the meat. Although most of the metal undoubtedly passes through the intestine over time, buckshot in the appendix is commonly seen in Alaskan natives (but usually not to the extent pictured here). Decades of ingestion probably resulted in this large accumulation. It is likely that poor dentition and advanced age are aggravating factors that prevent detection of the lead during mastication. A round piece of buckshot can be seen on the patient's right above the appendix — probably evidence of a recent meal.
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