The aim of this study was to measure lead (Pb) levels in blood (Pb-blood) in consumers of game meat, taking into account other possible sources of lead exposure. A spot blood sample was obtained from 95 subjects, and a questionnaire was used to collect general information and data on game meat consumption, hunting, wine drinking and other possible sources of lead exposure. Pb-blood was measured by inductively coupled plasma-mass spectrometry. Pb-blood was not influenced by age, sex, residence in an urban or rural area, consumption of game meat, tobacco smoking or hobbies associated with potential exposure to lead, and median Pb-blood was 1.7 (5th-95th percentile 1.0-5.3)µg/dL and 3.4 (0.9-6.1)µg/dL for game meat non-eaters and eater, respectively. A multiple linear regression analysis (containing the covariates sex, age, hunting, wine drinking, game meat consumption, tobacco smoking, shooting range, and occupational exposure) found an association with hunting (Pb-blood almost double in hunters) and wine drinking (40% higher in drinkers) but not with consumption of game meat or other parameters. Whether the higher Pb-blood level was due to inhalation of lead fumes while shooting with lead ammunition, to handling lead ammunition or both could not be ascertained.

Most ingested foreign bodies usually pass out in the feces uneventfully. Complications such as intestinal perforation and bleeding usually occur with sharp, thin, stiff, long, and pointed objects. This case describes the management of three lead pellets within the appendix vermiformis. A 45-year-old male visited our clinic complaining of a 4-month history of abdominal pain. The patient inquiry revealed that he had eaten hunted rabbit meat on numerous occasions and had unintentionally ingested three lead pellets. Plain abdominal films and a barium enema showed foreign bodies in the right lower abdominal quadrant. Since the lead pellets were thought to have migrated extraluminally, they were removed through laparotomy under fluoroscopic guidance. An appendectomy was performed. Pathologically, three lead pellets were embedded in the appendix, which showed signs of intramucosal inflammation. Foreign bodies causing appendicitis are rare. However, if stiff or pointed objects enter the appendicular lumen, there is a high risk of appendicitis, perforation, or abdominal pain. An appendectomy was required to remove the ingested lead pellets in the appendix.

A 37-year-old man was admitted to hospital after complaining of abdominal pain for the past two weeks. On admission the abdominal radiograph showed multiple radio-opaque flecks dispersed throughout the gastrointestinal tract. Blood testing showed hemoglobin level 8.7 g/dL and a blood lead level of 112.4 microg/dL. The family interview revealed that the patient had pica-like behavior since childhood. He was a site foreman and had been ingesting pieces of roofing plates for a few weeks. The patient was treated with laxatives and CaNa(2)EDTA therapy was initiated. The blood lead level then dropped to 69.9 microg/dL. The patient received two subsequent courses of oral succimer and the blood lead level decreased to 59 microg/dL 21 days after the first course. The follow-up abdominal X-ray 20 days after the first examination was normal. Four months later, an outpatient follow-up visit showed a blood lead level within normal limits (14.5 microg/dL) and a psychiatric follow-up was initiated. Lead poisoning following the ingestion of lead-containing foreign bodies is particularly rare in adults, while it is sometimes observed in children. Pica behavior is a well-identified risk factor of lead intoxication in children but is quite exceptional in adults, where it is usually considered to be a psychiatric condition. Other unusual sources of lead poisoning include the ingestion of lead bullets, ceramic lead glaze or glazed earthenware, lead-contaminated candies, ethnic or herbal remedies.