Foreign body ingestion (FBI) more commonly occurs in paediatric, psychiatric and intellectually impaired patients. Current guidelines primarily focus on paediatrics and adults with less emphasis on the adolescent population.

We present a case of a 16-year-old male with autism spectrum disorder (ASD), who presented with generalised abdominal tenderness. Abdominal X-Ray showed a radio-opaque sharp object in the right upper quadrant. Subsequent CT revealed a needle-like object in the proximal small bowel. Clinically, his symptoms continued to worsen despite no radiographic evidence of complications. However, his symptoms markedly improved without intervention and he was managed conservatively. This patient subsequently passed a 5cm needle three days after presentation. This article discusses the challenges involved in managing and communicating with intellectually impaired patients who present with foreign body ingestion. Guidelines from the most recent literature on managing adolescents with foreign body ingestion, particularly sharp object ingestion, are also discussed.