Perforation of the gastrointestinal tract secondary to ingestion of foreign bodies

Rectal abscess secondary to foreign body insertion: A case report

BACKGROUND

Rectal foreign bodies, though uncommon, present diagnostic and therapeutic challenges, particularly when they result from accidental ingestion. The nonspecific symptoms and the potential for serious complications necessitate a thorough and methodical approach to diagnosis and treatment. This case report aims to highlight the diagnostic complexities and management strategies involved in treating a patient with a rectal foreign body, focusing on the use of advanced imaging techniques and the importance of a multidisciplinary approach.

CASE SUMMARY

A 48-year-old male with a history of hypertension presented with a one-year history of post-defecation anorectal pain and mild post-defecation rectorrhagia. Initial evaluation revealed hemodynamic stability and a tender, non-mucosal lesion in the anterior left rectal region. Imaging studies, including colonoscopy, magnetic resonance imaging, and endosonography, identified an erythematous, exophytic lesion and a perirectal abscess containing a foreign body. Surgical intervention revealed necrotic tissue and purulent material, along with two solid foreign body fragments (bone or plant matter). Postoperative follow-up showed the patient in good condition, and pathology confirmed the fragments as mature bone.

CONCLUSION

This case underscores the diagnostic challenges posed by rectal foreign bodies with nonspecific symptoms and no clear history of ingestion.

Clinical features and endoscopic management of sharp wooden object ingestions: a systematic review of 479 cases

Background and aims

Ingested sharp objects pose increased risks of adverse events compared with other foreign bodies. We conducted the largest systematic review to date of sharp wooden object ingestions to elucidate patterns in clinical presentation and guide management practices.

Methods

Cochrane Library, Google Scholar, Ovid MEDLINE, Ovid Embase, PubMed, Scopus, and Web of Science Core Collection databases were searched for cases of adults who ingested sharp wooden objects. Descriptive statistics were reported for risk factors, clinical presentations, laboratory and imaging findings, adverse events, and treatments.

Results

Analysis of 479 cases showed that most patients were unaware of ingestion (74.8%) and toothpicks were the most common ingested item (92.5%). Male sex (70.1%), substance use (9.4%), and edentulousness (6.1%) were risk factors. Common symptoms included abdominal pain (83.7%) and fever (36.7%). Imaging identified the object in 48.1% of cases, with computed tomography being the most sensitive (54.7%). Objects were commonly found in the gastrointestinal tract (79.3%). They were consistently found in the gastrointestinal tract when patients were aware of ingestion or imaging showed an intraluminal/transluminal location. Endoscopy visualized the objects 76.1% of the time, with successful removal in 88.8% of cases; 4.7% of patients required surgery following endoscopic removal. Adverse events included perforation (87.5%) and abscess (33.0%), with a mortality rate of 5.0%.

Conclusions

Ingestion of sharp wooden objects presents heterogeneously and can lead to serious complications. Endoscopic removal is safe and effective. We propose a clinical algorithm to guide physicians in diagnosing and managing suspected sharp wooden object ingestion.

Laparoscopic surgery for impacted dentures in the descending colon: A case report

INTRODUCTION AND IMPORTANCE

Denture ingestion, commonly seen in older adults, can also occur in younger individuals. Most dentures require intervention as they cannot be excreted naturally. We report a case of a young male undergoing laparoscopic surgery to remove dentures impacted in the descending colon two months post-ingestion.

CASE PRESENTATION

A 30-year-old male presented with intermittent left lower quadrant abdominal pain for three days. He had accidentally swallowed his dentures two months earlier. Abdominal X-ray showed a radiopaque foreign body in the descending colon. Endoscopic retrieval attempts failed, necessitating urgent surgery. The dentures were removed successfully through laparoscopic surgery, and the perforation was closed using continuous horizontal PDS 4.0 sutures. The postoperative course was uneventful and the patient was discharged on postoperative day four.

CLINICAL DISCUSSION

Denture ingestion poses a significant risk due to the nature of the object, often requiring removal as it cannot pass through the gastrointestinal tract. Removable dentures are a known risk factor for such accidents. Diagnosis typically involves abdominal X-rays or CT scans. Endoscopic retrieval is often attempted first but carries a risk of perforation, which may require emergency surgical intervention.

CONCLUSION

Surgical approaches depend on the location and extent of perforation and the patient's abdominal condition. Early laparoscopic intervention should be considered in cases where surgery is indicated, as it offers a minimally invasive and effective solution.

Distal sigmoid perforation secondary to migration of a biliary stent: A case report

INTRODUCTION

Colonic perforation is a rare but critical condition that can lead to significant morbidity and mortality, particularly when iatrogenic in nature, such as from biliary stent migration, which occurs in less than 1 % of cases. This underscores the need for awareness among healthcare professionals regarding this potential risk and the importance of timely diagnosis and management.

CASE PRESENTATION

We present an 80-year-old female patient admitted with severe abdominal pain and vomiting. Radiological examinations revealed free air under the diaphragm and a perforation at distal sigmoid part of the colon caused by a lodged foreign body. Instead of the standard resection and colostomy, we opted for exclusive repair of the perforated area due to the patient's stable condition. Subsequent investigations identified the foreign body as a migrated Common Bile Duct (CBD) stent from a previous ERCP procedure. The patient underwent successful repair and recovered fully after one week of hospitalization, with no complications during a six-month follow-up. Notably, it must be included that the work has been reported in line with the SCARE criteria.

CLINICAL DISCUSSION

Management of sigmoid perforation following CBD stenting requires careful consideration of patient stability and perforation characteristics. In this case, primary repair was justified to preserve bowel continuity. Early recognition and intervention are crucial for effectively managing iatrogenic perforations.

CONCLUSION

Sigmoid perforation, while rare, can arise from biliary stenting procedures; thus, patients with abdominal pain post-procedure should be thoroughly investigated. To ensure patient safety and minimize the risk of surgical complications, it is important to remove the plastic biliary stents promptly after their intended use. Tailored management strategies are vital to prevent severe outcomes and improve prognosis, demonstrating that individualized treatment can minimize morbidity associated with invasive surgical procedures.

Accidental Fish Bone Ingestion Leading to Gastric Perforation: A Diagnostic Challenge

Accidental ingestion of animal bones, including fish bones, often goes unnoticed and rarely leads to acute medical complications. However, in rare cases, fish bones can perforate the gastrointestinal tract, causing serious complications such as perforation, abscess formation, or fistula development, necessitating emergent surgical intervention. This case report describes a rare case of gastric perforation by a fish bone ingestion, complicated by perigastric and hepatic abscesses. The patient initially presented to a rural emergency department with acute abdominal pain, where limited imaging resources posed a diagnostic challenge. After repeated rural emergency department presentations, a definitive diagnosis was only established after the patient was transferred to a tertiary center and evaluated using computed tomography (CT) imaging. This helped to guide appropriate surgical management, and an emergency laparotomy was performed, which was followed by an uneventful recovery. We emphasize the critical role of CT imaging in diagnosing fish bone perforation, discuss common sites of perforation, and highlight the need to consider this pathology as a differential diagnosis in patients with undifferentiated abdominal pain.

Medication Blisters: A Rare Cause of Bowel Perforation

Foreign body ingestion is a common occurrence in vulnerable populations, predominantly at the ends of the age spectrum. While most cases are uncomplicated, some patients may require endoscopic or surgical intervention to prevent serious complications. Therefore, accurate and detailed radiological evaluation is essential for therapeutic decision-making. We present the case of an 80-year-old woman presenting with abdominal pain and radiological evidence of a foreign body in the small intestine. A conservative treatment approach was initially proposed due to the absence of complications and the hypothesis that a fishbone was the cause. However, her condition deteriorated due to bowel injury, complicated by bleeding and perforation. Multiplanar and 3D reconstructions identified the object as a medication blister located in the sigmoid colon. Urgent surgical intervention allowed for the retrieval of the object and the closure of the bowel perforation. This case highlights the importance of early, detailed, and accurate radiological evaluation to identify the characteristics of foreign bodies and guide timely intervention.

Unforeseen consequences: A case report of misdiagnosis in pediatric ingestion of a fish bone

Children are frequently reported as cases of foreign body ingestion, with fishbone ingestion being particularly prevalent in communities where fish consumption is common. Although many instances of foreign body ingestion resolve spontaneously, the ingestion of sharp objects like fishbones poses a greater risk of morbidity and mortality due to their propensity for causing complications. Furthermore, incidents of foreign body ingestion often present with nonspecific symptoms or may go unnoticed, potentially leading to misdiagnosis and complicating the clinical course. We present a case of a 2-year-old boy initially misdiagnosed with constipation and treated with laxatives due to intermittent progressive abdominal pain. Subsequently, he presented to the emergency department where radiological and laboratory investigations revealed signs of inflammation and localized abdominal fluid collection containing a linear hyperdense object, indicating complicated foreign body ingestion with perforation. Urgent laparotomy revealed an omental abscess, which was excised, and the perforation site was repaired with sutures. This case underscores the risk of misdiagnosis and the importance of timely recognition and management. It also emphasizes the critical role of imaging, particularly computed tomography, in accurate diagnosis and differentiation from other common conditions.

Hematemesis in a young patient: When the cause is ingested: A case report

Foreign bodies may be ingested accidentally or intentionally. Generally, they pass through the digestive tract without causing complications unless they become lodged. Patients often present with nonspecific clinical symptoms, and diagnosis is frequently delayed because they do not recall ingesting anything. We report the case of a 20-year-old man who was admitted to the emergency room for acute moderate hematemesis. The patient had no significant medical history. An urgent, nonsedated upper gastrointestinal (GI) endoscopy was performed, which revealed bleeding but no foreign objects. However, an abdominal CT scan identified a linear calcified object in the antrum, which was later confirmed to be a chicken bone upon endoscopic extraction. Ingested foreign bodies typically pass through the digestive tract without incident. However, long, sharp, and thin objects can remain in the gastrointestinal tract for 7-10 days and may become lodged in areas of physiological narrowing. This can lead to complications such as bowel obstruction, perforation, or bleeding.

Fishbone Foreign Body Ingestion With Gastric Impaction and Intestinal Micro-perforation in an Adult Female: A Case Report

Foreign body ingestion of fishbones is a very common complaint where most foreign bodies travel safely through the gastrointestinal tract (GIT) without any serious complications. However, its clinical presentation is nonspecific, and its clinical severity can vary widely, thus requiring the use of conservative and or invasive treatment modalities. In this case report, we present a case of a 42-year-old female who reported eating fish two days prior to presenting with upper gastrointestinal tract (GIT) foreign body impaction in addition to a lower GIT micro-perforation secondary to fishbone ingestion, both of which were successfully managed with conservative, nonsurgical treatment modalities. Impaction, perforation, or obstruction of fishbone foreign bodies often occur at GIT angulations or narrowing. Clinical diagnosis of foreign body ingestion requires the use of multiple modalities such as a detailed history, physical exam, radiographic evaluation, and endoscopic evaluation as needed. Treatment depends on multiple factors and can be conservative or surgical in nature. Fishbone foreign body ingestion is a common complaint and rarely leads to severe complications. However, its diagnosis can be difficult without an explicit history highlighting ingestion of fishbones and requires the use of appropriate imaging modalities such as computed tomography (CT) scans. Subsequent management may require conservative or invasive treatment modalities based on the location of the fishbone, and the presence or absence of accompanying complications such as peritoneal signs, sepsis, and radiographic identification of bowel perforation.

Ileal perforation peritonitis secondary to accidental ingestion of a chicken bone: A case report

INTRODUCTION AND IMPORTANCE

Ileal perforation is a rare but serious condition that can arise from accidental ingestion of foreign objects. This report discusses an unusual case of ileal perforation peritonitis caused by ingestion of a chicken bone.

CASE PRESENTATION

A 60-year-old male presented with acute generalized abdominal pain, fever, nausea, and vomiting for three days. A physical examination revealed signs of peritonitis. Imaging results were unremarkable. Emergency laparotomy revealed perforation in the ileum caused by the chicken bone. The perforated segment was resected, and primary anastomosis was performed.

CLINICAL DISCUSSION

Ingestion of foreign bodies, although common, rarely leads to gastrointestinal perforations. Among these foreign bodies, chicken bones are rarely reported, making the diagnosis challenging because of nonspecific symptoms and low clinical suspicion. Prompt surgical intervention is crucial for managing complications such as peritonitis and sepsis.

CONCLUSION

This case highlights the importance of considering foreign body ingestion in the differential diagnosis of acute abdominal pain, particularly in patients without an obvious cause of peritonitis. Early detection and timely surgical intervention are essential to improve patient outcomes.

Migrated toothpick causing a hepatic abscess with portal vein thrombosis: A case report and review of literature

Key Clinical Message

Accidental foreign body ingestion is the most common hidden cause of abdominal pain. A high index of suspicion should be implemented in patients with unresolved abdominal pain. Here we reported a 54-year-old patient with vague abdominal pain who had a successful laparoscopic removal of a toothpick.

Abstract

Toothpicks and fish bones are considered one of the most common accidentally ingested foreign bodies. Fortunately, most patients are asymptomatic. About 80%-90% of ingested foreign bodies pass through the gut spontaneously within a week. We present a case of a 54-year-old female with chronic epigastric pain and fever found to have a foreign body (toothpick) that penetrated the stomach and migrated to the liver causing liver abscess with portal vein thrombosis. The patient was managed with laparoscopic removal of the foreign body with an uneventful postoperative course.

Acute intestinal obstruction secondary to ingested foreign body in an adult with autism spectrum disorder: A rare case report and review of literature

Key Clinical Message

Foreign body ingestion is common in pediatric age group however can be found in any age group with intellectual disability and neurodevelopmental delay. There is usually a delay in presentation and interventions following foreign body ingestion in patients with neurodevelopmental delay, leading to increased morbidity, mortality, and complications owing to inability of such patients giving relevant history. Most ingested foreign bodies naturally pass through the digestive tract without untoward effects. Only a few patients may require surgical interventions. Principle of management should be to reduce anxiety among patients and their visitors. Speedy recovery is enhanced so that they can return to their familiar environment soon.

Abstract

Foreign body ingestion is common in pediatric populations and may be found in any age group with intellectual disability and neurodevelopmental delay. As the patient cannot give a clear and relevant history, there is usually a delay in presentation and interventions following foreign body ingestion in patients with neurodevelopmental delay, leading to increased morbidity, mortality, and complications. Most foreign bodies pass through the digestive system without any complications, and very few require surgical intervention. The goal should be to reduce anxiety among patients and their visitors and to enhance speedy recovery so that they can return to their familiar environment soon. Here we report a case of Acute intestinal obstruction secondary to ingestion of the head portion of a doll which was managed with emergency laparotomy with enterotomy and removal of foreign body in a 16 years female with Autism Spectrum Disorder.

Incidental Finding of a Fish Bone Perforation in the Pylorus Mimicking Acute Cholecystitis

We present a case of a 43-year-old man with Crohn's disease who presented with epigastric and right upper quadrant abdominal pain, initially suspected to be acute cholecystitis or a Crohn's flare-up. CT revealed a curvilinear, hyperdense foreign body adjacent to the duodenum, concerning micro-perforation. Endoscopic examination confirmed findings of a 3 cm fish bone lodged in the pylorus. Endoscopic extraction was successful without significant mucosal damage, and the patient recovered well postoperatively. This case highlights the rarity of pyloric perforation secondary to fish bone ingestion and highlights the importance of considering this diagnosis in patients presenting with unexplained acute abdominal pain, as prompt recognition and intervention are essential for favorable outcomes.

A 37-Year-Old Schizophrenic Woman With Abdominal Pain

Introduction

Internal fistula across the posterior wall of stomach and the transverse colon caused by foreign bodies in the alimentary tract presents an extremely rare medical entity.

Presentation of case

We report an aschizophrenia female patient with onset of internal fistula across the posterior wall of stomach and the transverse colon triggered by swallowed magnetic metal beads. The patient was admitted to the emergency room of Northern Jiangsu People's Hospital because of acute right lower abdominal pain. Emergency routine abdominal CT scan revealed acute appendicitis and a set of foreign body in digestive tract.

Discussion

The foreign body in the stomach was removed by open surgery after tentative Endoscopic foreign body removal and laparoscopic appendectomy and exploration. In the process of exploring the gastric wall, it was found that one of magnet beads was embedded in the posterior wall of stomach and adhered to part of the transverse colon. After separation, it was found that an internal fistula was formed across the posterior wall of stomach and the transverse colon. As the patient ate only a small amount of food within 2 days, and the intestines were in good condition, we performed partial transverse colectomy, end-to-side anastomosis and gastric wall repair.

Conclusion

This case shows that for long-term foreign bodies in the digestive tract, we should be beware of the onset of gastrointestinal perforation. Moreover, perforation caused by the force acting on a blunt foreign body often results in atypical imaging findings, and the diagnosis of perforation cannot be clearly determined by imaging findings such as the presence of free gas downstream of the diaphragm. This poses new challenges for clear diagnosis and treatment.

Descending Colon Perforation Due to Ingestion of Foreign Body

Foreign body ingestion is a common reason for emergency department (ED) visits, with rare complications necessitating immediate surgical intervention. This case report discusses diagnosis and treatment, emphasizing the importance of prompt intervention. A 45-year-old male with dentures presented with acute left abdominal pain. Diagnostic tests identified a foreign body in the descending colon, leading to laparoscopic surgery. Early laparoscopy offers a safe and reliable alternative to exploratory laparotomy. This case underscores the significance of swift diagnosis, preventing severe complications like peritonitis, obstruction, and hemorrhage. In conclusion, while foreign body ingestion is common, intestinal perforation remains extremely rare. Physicians should consider it in their differential diagnosis, with computed tomography (CT) and rapid surgical intervention as crucial components of proper management.

An Unusual Case of Cecal Perforation: Accidental Ingestion of a Tooth in an Elderly Trauma Patient

Foreign body ingestion is a common occurrence in the United States, with the majority passing asymptomatically. In cases where complications occur, such as intestinal perforation, it may present as an acute abdomen with diagnostic challenges regarding the etiology. A 70-year-old male was brought to the emergency department (ED) after he jumped from the second floor of a burning building, sustaining 10% second-degree burns to his forearms. He was intubated for concerns of inhalational injury and resuscitated. His intensive care unit (ICU) course included the management of respiratory failure, sepsis, and acute kidney injury. On hospital day 28, imaging showed moderate pneumoperitoneum with ascites. He was taken for abdominal exploration, during which it was noted that there was gross fecal contamination and a 1 cm cecal perforation. After resection of the ileocecum, it was left in discontinuity due to hemodynamic instability and contamination. He was brought for a second-look laparotomy in 48 hours, and an incisor tooth was found in the right pelvis, and an ileocolic (ileum-ascending colon) anastomosis was performed. His post-operative course was complicated by an anastomotic leak and an intra-abdominal collection. Despite attempts at source control with percutaneous drainage, the patient remained septic with a poor prognosis. Goals of care were discussed, and the decision was made to de-escalate care. Although there is literature on foreign body ingestion resulting in intestinal perforation, there is a paucity of literature highlighting the importance of dental exams in elderly trauma patients, the incidence of perforation due to tooth ingestion, and maintaining a high index of suspicion for an acute abdomen in unusual presentations of sepsis.

Multiple abdominopelvic abscesses caused by fishbone: A case report of rare etiology and literature review

INTRODUCTION AND IMPORTANCE

Foreign body ingestion, particularly fishbone, is a prevalent medical complaint in the emergency department. Usually, these foreign substances pass through the gastrointestinal tract without causing any complications. The clinical manifestations of foreign body consumption are non-specific.

CASE PRESENTATION

A 32-year-old male patient presented to our hospital with severe abdominal pain. Physical examination revealed a distended abdomen and tenderness. Plain chest and abdominal X-rays were unremarkable. The performed computed tomography (CT) of the abdominopelvic region showed multiple abscesses. Then, an exploratory laparotomy was decided during which a foreign body, a fishbone, was detected and the affected omental mass was resected, and abscess drainage was done. The resected specimen was sent for histopathological studies. The postoperative period was uneventful.

CLINICAL DISCUSSION

Perforation of the intestinal wall by fishbone ingestion is an unusual entity. The clinical features of intestinal perforation are usually non-specific resulting in delayed diagnosis. Based on individual situations, the treatment strategy can be surgical or non-surgical.

CONCLUSION

Even though ingesting a foreign body is a frequent complaint in clinical practice, its repercussions are extremely rare. Our case presented multiple intra-abdominal abscesses and perforation as a complication of accidental fishbone ingestion.

Two Cases of Severe Complications Due to an Esophageal Fish Bone Foreign Body

Cases of foreign body ingestion are encountered relatively often in clinical settings; however, serious complications are rare. In such cases, mediastinal abscess due to esophageal perforation can become a life-threatening complication. We encountered two cases of severe complications due to an esophageal fish bone foreign body. The first case was a 40-year-old male with an intramural esophageal abscess due to a fish bone after eating fish five days before visiting the hospital. The patient underwent surgical treatment, but the esophageal abscess did not improve; so, the abscess was drained through endoscopic mucosal dissection, and the abscess improved. In the second case, a 64-year-old male, who had eaten fish three days before visiting the hospital, had esophageal perforation by a fish bone, and abscess formation in the mediastinum and the lesser sac in the abdominal cavity were observed. Although surgical treatment was performed, the intra-abdominal abscess formation was not controlled; so, percutaneous drainage (PCD) was inserted, and the abscess improved. Both patients were discharged without any complications. Here, we report two cases that were improved through surgical treatments and additional treatments such as endoscopic dissection and PCD.

A Right-Angled Thorn in the Bowel: A Curious Case of Small Bowel Perforation

We present a 45-year-old man with small bowel perforation resulting from the inadvertent ingestion of a right-angled thorn of the Gum Arabic plant (Vachellia nilotica). The diagnosis was made, and an emergency laparotomy was performed for suspected enteric peritonitis. The thorn was found projecting from the terminal ileum with a minimal intra-peritoneal fluid collection. The thorn was removed, and the perforation site was repaired primarily with absorbable sutures. The lack of a reliable history of foreign body ingestion makes it impossible to arrive at an accurate preoperative diagnosis in patients presenting with perforation peritonitis. Radiological investigations have a low sensitivity for detecting radiolucent vegetative foreign bodies as the cause of bowel perforations. Primary repair should be preferred over resection procedures in the management of foreign body-induced small bowel perforations.

Perineal necrotizing soft tissue infection secondary to rectal perforation from a large fish bone -a painful lesion not to be missed

Necrotizing soft tissue infection caused by a large 70 mm fish bone that led to a single perforation of the rectum is an incredibly rare phenomenon. We report a case of an adult male in his 50s who presented with perianal pain. A prompt computed tomography (CT) scan revealed a foreign body had perforated through the rectum into the retrorectal space with associated gas locules, indicating a necrotizing infection. In addition, our case report explores the principles of wide exploration and debridement, the role of a defunctioning colostomy in perineal wound management, and principles of wound closure in the context of a foreign body causing significant perineal sepsis.

Life-threatening esophageal perforation due to blister pack ingestion

Most ingested foreign bodies do not cause serious complications. In rare cases, elderly people with cognitive decline may unintentionally swallow a blister pack while trying to take medicine. When a blister pack is separated into individual parts, the separated parts have sharp edges that can cause serious damage if ingested. We report a case of an elderly patient who unintentionally ingested a blister pack, which led to esophageal perforation and ultimately his death.

Sharp-Pointed Foreign Body Ingestion in Pediatric Age

OBJECTIVES

To assess the clinical complications reported after the ingestion of sharp/pointed foreign bodies (FBs) in pediatric age, their incidence among all FB ingestions, and the features and clinical presentation of children.

STUDY DESIGN

We have recruited all consecutive patients aged 0-14 years, admitted for sharp/pointed FB ingestion. Clinical data until hospital discharge were accurately recorded, including both children with esophagogastric FB retention who underwent endoscopic removal and children who were radiologically followed-up till spontaneous FB expulsion. Clinical outcomes were recorded for each patient, with special reference to possible prolonged retention and wall perforation during the intestinal passage.

RESULTS

We have enrolled 580 children (males/females: 292/288; age range: 11-180 months; mean age ± standard deviation: 50.5 ± 42 months). Sharp/pointed FBs mainly included fragments of metal 270 of 580 (46.55%) and glass 180 of 580 (31%). FBs were endoscopically removed in 79 of 580 (13.6%) children whereas the remaining FBs passed through the gastrointestinal tract over an overall mean time of 29 hours. No cases of intestinal perforation nor prolonged retention were observed. In 3 of 65 (4.6%) procedures the endoscopist faced an uncomfortable endoscopic removal due to the shape and size of the FB which hampered the retrograde passage through the esophageal sphincters.

CONCLUSIONS

Our original and extensive data emphasize that accidental ingestion of sharp/pointed FB ingestion is a current issue in pediatric age, especially in toddlers. Metal and glass objects are the most involved FBs and their endoscopic retrieval may not be easy in about 5% of cases. Fortunately, in our pediatric sample no surgical intervention was needed.

Ingested Chicken Bone (Xiphoid Process) in the Anal Canal: A Case Report and Literature Review

Accidental foreign body (FB) ingestion is common in the elderly, particularly edentulous and denture wearers. The most commonly ingested FBs are food-related, including fish and chicken bones. While small FBs can pass through the gastrointestinal tract without any complications, large or irregular-shaped FBs usually cause complications. These complications include choking, ulceration, perforation, fistula, abscess formation, or even death. Ingestion of a large chicken bone that reaches the anal canal without causing injury is extremely rare. We present a rare case of accidental chicken bone (xiphoid process) ingestion that manifested itself by projecting from the anus while defecating. Interestingly, the patient did not experience any food choking or abdominal pain, nor did she have any type of dementia. However, the patient could not grind food properly due to the loss of her upper molar teeth, which made her develop a habit of rapid swallowing. On examination, the chicken bone was seen within the anus with a sharp edge embedded in the mucosal wall. While a plain pelvic X-ray failed to display the FB, a pelvic CT scan with a 3D illustration showed its dimensions (5.0 x 2.5 x 3 cm). A plain pelvic CT scan confirmed the presence of the bone-contrast FB within the anal canal without injuring the surrounding anatomical structures. The FB was gently manipulated and successfully extracted after administering 5 ml of lidocaine gel enema. The patient was counseled regarding proper chewing habits, and she was referred to a dental clinic for a professional assessment. Seven days later, the patient was seen again at the clinic for a follow-up and was found to have an uneventful recovery. Maintaining good dental health and proper eating habits, as well as increasing awareness among edentulous individuals and denture wearers, are required to prevent accidental FB ingestions.

Perforation of ileum by unnoticed toothpick ingestion presenting as acute appendicitis: A case report

INTRODUCTION

Many distinct pathologic disorders can cause acute abdomen, and it can be challenging for doctors to distinguish between them. Appendicitis and small bowel perforation are two examples. This case is being reported to highlight a rare instance in which acute appendicitis can be mistaken for ileal perforation by sharp solid objects.

CASE PRESENTATION

We discuss the case of a 9-year-old boy who arrived at our hospital complaining of right iliac fossa abdominal pain that started two days earlier with no other associated symptoms. Physical examination revealed right iliac fossa tenderness and rebound tenderness. The results of the imaging and laboratory tests were inconclusive; therefore, the patient was admitted for observation and further assessment. Re-evaluation 4 h after admission found no clinical improvement, and abdominal examination revealed guarding and rebound tenderness, prompting the surgical team to opt for an appendectomy. During surgery, an elliptical incision was made to remove a sharp foreign body penetrating the ileum.

DISCUSSION

Even during surgery, diagnosing acute appendicitis is difficult. Some cases of small bowel perforation caused by foreign body ingestion have been linked to a clinical picture similar to acute appendicitis, while others present with acute peritoneal signs. This report describes a sealed ileal perforation by a sharp solid object, manifested as acute appendicitis.

CONCLUSION

Perforation of the small bowel by sharp solid objects may easily be missed on imaging, probably related to their ability to seal off the resulting perforation. A sharp solid object's perforation seems to cause localized tenderness mimicking appendicitis.

Unusual Cause of Small Bowel Perforation: A Case Report

Ingesting foreign bodies in the GI tract is not common, especially among adults. Here, we present a case of a 38-year-old male with a hyper-dense linear foreign body perforating the distal ileum, which turned out to be a 5-cm long fish bone eaten about a month before the presenting symptoms.

Pesky Pesce: A Forgettable Fish Dinner with a Late Surprise, a Perianal Abscess

Clinical presentation after ingestion of foreign body is a common finding in surgical practice. Perianal sepsis due to a foreign body is, usually, secondary to introduction via the trans-anal route. The case here reported is extremely rare since an ingested fishbone passed asymptomatically through most of the gastrointestinal tract, with resultant late-onset ischiorectal abscess. Moreover, clinical evidence of the perianal abscess manifested one month after the fishbone had been ingested. The final localization of the fishbone-lying anterior to the sacrum-complicated the preoperative and intraoperative detection of the ingested foreign body.

Percutaneous extraction of metallic foreign body from pyogenic liver abscess

We report a case of a 35-year-old male who developed a pyogenic liver abscess (PLA) secondary to a foreign body that migrated from the transverse colon into the liver. The mainstay of treatment of PLA requires removal of the foreign body, most frequently performed surgically. Few case reports exist of percutaneous removal. As our patient was hemodynamically stable at time of presentation, he underwent successful percutaneous transhepatic removal of the foreign body, avoiding any need for surgical operation.

Intestine perforation by an accidental ingested SARS-CoV-2 nasopharyngeal swab; a case report

Introduction and importance

Gastrointestinal tract perforations as a result of foreign body ingestion are rare. Most ingested foreign bodies pass the intestines without complications. However, in 1 % of cases intestinal perforation occurs. We present the case of a 56-year old patient with an extensive surgical medical history who presented at the emergency department with progressive abdominal pain two weeks after accidental SARS-CoV-2 swab ingestion.

Case presentation

On presentation patient was tachycardic and had generalized abdominal tenderness. A CT scan showed free intraperitoneal air and fatty infiltration of the ileocecal anastomosis (after an ileocoecal resection at the age of 46) continuing to the distal sigmoid. Emergency exploratory laparotomy revealed a covid swab in the abdominal cavity with an indurated area of the sigmoid without perforation. Post-operative care was uneventful, and patient was dismissed after four days.

Clinical discussion

Due to his medical history and the fact he was advised to regularly self-test for COVID, he routinely performed an oropharyngeal swab. Unfortunately, this resulted in swallowing the swab. A perforation tends to happen in regions of acute angulation, such as an anastomosis. Although the CT scan suggested the perforation was at the ileocecal anastomosis, no perforation was found during surgery, while the swab was found loose in the peritoneal cavity.

Conclusion

Initial treatment should focus on endoscopic removal. In the case of gasto-intestinal perforation, surgery becomes the treatment of choice. A foreign body can migrate to peritoneal cavity without peritonitis or visible perforation perioperative.

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To the authors best knowledge this is the first case of intestinal perforation after an ingested SARS-CoV-2 nasopharyngeal swab.

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A foreign body can migrate to peritoneal cavity without peritonitis or visible perforation perioperative.

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If endoscopy fails to remove it and there is a high risk of perforation, surgical removal should be considered before severe complications develop.

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In the case of gasto-intestinal perforation, surgery becomes the treatment of choice.

A fatal perforation of the distal ileum from an ingested fish bone: A case report

INTRODUCTION AND IMPORTANCE

Foreign body-induced perforations of the ileum are rare consequences among adults.

PRESENTATION OF CASE

This is a case report of a delayed presentation of an ileal perforation and concurrent faecal peritonitis presented as an acute abdomen, resultant from an ingested fishbone, which led to fatality despite urgent laparotomy.

CLINICAL DISCUSSION

Perforations following ingested foreign bodies are frequently unanticipated clinically, and diagnosed during advanced imaging studies or surgical interventions. Endoscopy, laparoscopy, and laparotomy have been used during surgical management in reported cases; however, prior early identification is pivotal for good outcomes as delayed presentations and delayed diagnosis carry a poorer prognosis.

CONCLUSION

Despite fish bones being frequent foreign bodies in the gastrointestinal tract and the majority causing no life-threatening adverse effects, they are the leading foreign bodies instigating gastrointestinal perforations. A high degree of suspicion is required when attending to patients with suspected gastrointestinal perforations and absent typical findings in routine imaging, where fish bones could be the aetiology.

Gastrointestinal perforations by ingested foreign bodies: A preoperative diagnostic flowchart-based experience. A case series report

BACKGROUND

Gastrointestinal tract perforation is the most harmful complication of Foreign Body (FB) ingestion, besides diagnostic delay adversely affects the outcome. This paper aims to present our preoperative diagnostic flowchart and describe the surgical management in a Tunisian center.

METHODS

A retrospective review of 48 patients with gastrointestinal perforation by ingested FB treated in the surgery department of Jendouba Hospital. January 2010-December 2020.

RESULTS

48 patients were treated for gastrointestinal tract perforation induced by FB ingestion. The mean age was 56.6 years. The sex ratio was 2/1. Acute abdominal pain was reported in all the patients. 35 patients had abdominal X-ray that showed a FB in 12 cases. CT scan was performed in 38 patients and identified the FB in 28 cases. Postoperative proofreading has identified a preoperative missed diagnosis of FB perforation in 5 cases, all before applying the diagnostic flowchart. All patients underwent open surgery after a median time of 7.12 h. This duration decreased after applying the flowchart (8.21 h versus 5.6 h). 33 patients had a terminal ileum perforation. Enterectomy was performed in 33 patients. Postoperatively, there was one abdominal abscess, one pulmonary embolism, one refractory septic choc, and one wound abscess. The median hospital stay was 6.35 days. The mortality rate was 6.25%. All patients managed with enterostomy had their stoma closed after 3-5 months.

CONCLUSIONS

The challenge of gastrointestinal perforation due to FB ingestion is accurate diagnosis and early management. A standardized initial assessment based on a diagnostic flowchart is helpful to achieve this goal and improve outcomes.

Uncommon Cause of Right Upper Quadrant Pain Treated by Laparoscopic Surgery: A Case Report

INTRODUCTION

Right upper quadrant pain is a very common symptom of cholecystitis. Right upper quadrant pain caused by fish bone perforation of the stomach wall is rare.

CASE PRESENTATION

We report a 42-year-old woman who was admitted to our hospital with "1-month history of dull progressive right upper quadrant pain radiating to the back." Computed tomography of the abdomen revealed a linear, high-density body between the stomach wall and the liver. On history, the patient stated she had eaten a bony fish a month prior but did not note any significant pain at the time. Laparoscopy revealed a fish bone 2 cm in length half on the surface of the caudate lobe of the liver, and no perforation of the gastrointestinal tract was found. The postoperative course was uncomplicated, and the patient was discharged home on day 3 after surgery.

CONCLUSION

The case of right upper quadrant pain caused by the fish bone is very rare. Radiological examinations play a significant role in the diagnosis of fish bone ingestion. Laparoscopic surgery is technically feasible and safe for the treatment of patients with fish bone ingestion.

Spontaneous Partial Percutaneous Extrusion of Swallowed Metallic long Spoon: A Case Report

Foreign body ingestion is a commonly encountered clinical challenge. Most of these objects pass spontaneously, but long objects could be retained leading to uncommon complications. There seem to be no record of percutaneous extrusion of ingested spoon in literature. We report a case of 20 year old lady who swallowed a long metallic spoon. It got retained in the stomach for a month without obstructive symptoms, until the tail end of it eroded onto the skin. It was retrieved through an open gastrotomy. Patient had an uneventful postoperative recovery. Clinicians should be mindful that ingested large foreign bodies may be delayed in presentation. Whereas our index patient had open surgery, minimally invasive retrieval approaches could be considered when comparable cases are encountered.

Hepatic abscess following foreign body perforation of the colon: A case report

Liver abscess following foreign body perforation of the gastrointestinal tract is uncommon. Preoperative diagnosis is challenging as the ingestion of foreign body most often goes unnoticed with non-specific presentation. We report a case of a 68-year-old male patient presenting with abdominal pain and anorexia. His investigations and cross-sectional imaging revealed a liver abscess. A colonoscopy performed to find an etiology revealed an incidental finding of a colonic perforation from an impacted denture, which was successfully removed endoscopically. Therefore, pyogenic liver abscesses remain a therapeutic challenge despite advances in imaging and therapy. The case reflects the importance of investigating for etiology of unexplained liver abscesses. The patient made an uneventful recovery following abscess drainage by image-guided pigtail stent insertion. The colonic perforation was managed conservatively.

Spontaneous resolution of gastric perforation caused by an ingested foreign body: a case report

Foreign body ingestions are commonly seen and are usually uneventful. Very rarely, ingested foreign bodies will cause perforation of the gastrointestinal tract, which can lead to peritonitis, abscesses or fistulation. This is the case of a patient with vague abdominal pain after voluntary ingestion of bleach and an ink pen. The ink pen was found lodged in the gastric antral wall on esophagogastroduodenoscopy. The foreign body spontaneously migrated into the gastric lumen and was successfully removed with endoscopy.

Endoscopic Removal of Sharp-Pointed Foreign Bodies with Both Sides Embedded into the Duodenal Wall in Adults: A Retrospective Cohort Study

PURPOSE

Sharp-pointed FBs with both sides embedded in the duodenal wall are rare. Compared with smooth edged FBs, sharp objects are more likely to be associated with significant adverse events, when penetrating the wall of the digestive tract. The clinical features of patients who experienced sharp-pointed FBs embedded in both sides of the duodenum were retrospectively analyzed, as were the efficacy and safety of endoscopic removal of these FBs.

PATIENTS AND METHODS

This retrospective study included 21 adults with both sides of sharp-pointed FBs embedded into the duodenal wall who were admitted to the Second Xiangya Hospital in China between January 1, 1996, and May 31, 2021. Data associated with the endoscopic removal of these FBs were collected from the electronic medical record system (EMRS) of the hospital.

RESULTS

The incidence rate of duodenal total FBs and FBs embedded in both sides was 8.87% and 1.03%, respectively. The success rate of endoscopic treatment was 100.00% in 124 patients without embedded duodenal FBs and 97.14% in 35 patients with one side embedded duodenal FBs. Of the 21 patients with FBs embedded in both sides of the duodenal wall, endoscopic removal was successful in 85.71% of patients, whereas 14.29% required surgery. FBs removed from these patients included toothpicks in 12; needles in 3; jujube pits in 2; and a chopstick, dentures, fish bones, and chicken bones in one each. Most of these 21 FBs were located in the bulb and descending duodenum, followed by the third part of duodenum.

CONCLUSION

Sharp-edged FBs with both sides embedded in the duodenal wall are rare. Endoscopic removal may be considered as a feasible, safe, and effective method of removing sharp-pointed FBs with both sides embedded in the duodenal wall. And if endoscopic removal is unsuccessful, surgical management can be a secondary option.

Foreign body ingestion-related peritonitis in an elderly peritoneal dialysis patient

Among peritoneal dialysis patients, peritoneal dialysis-related peritonitis is a well-known complication, but it can also be non-peritoneal dialysis-related (e.g. ruptured appendix). Ileal perforation by foreign bodies such as blister pill packs can be seen in the emergency room. Differentiating this from peritoneal dialysis-related peritonitis can be difficult, since they can have both identical presentations. Computed tomography can be of value in detecting abscess, thickening of the digestive wall or adhesions, and exclude other causes of intra-abdominal sepsis. Because of the aging population, ingestion of foreign body can be expected to rise. We therefore recommend that blister pill packs should not be divided into single-dose pieces, and we invite elderly patient’s entourage to check medication administration. Furthermore, manufacturing efforts are highly recommended to improve blister pill pack’s design, to avoid accidental ingestion. We report the case of an elderly peritoneal dialysis patient who presented with peritonitis due to ileal perforation because of blister pill pack ingestion.

Undiagnosed Accidental Blister Pack Pill Ingestion in Elderly

Ingestion of foreign body is a common occurrence in children. Most of these foreign bodies pass through gastrointestinal tract without causing any symptom or complication. Sharp edgy objects have propensity to cause tear or damage to the mucosal linings of gastrointestinal tract. Here is an interesting case of unintentional ingestion of blister pack pill in an elderly, whose initial presentation was intestinal obstruction and later on developed intestinal perforation.

Intestinal perforation on an incarcerated incisional hernia secondary to an ingested foreign body. Report of a rare case

Ingestion of foreign bodies (FBs) is common and rarely has consequences for the patient, but sometimes it can originate gastrointestinal perforation and lead to devastating consequences if unrecognized. Therefore, whenever present, bowel perforation demands immediate surgical treatment.

An 89-year-old woman with an incarcerated incisional hernia, whose imaging study was consistent with intestinal occlusion and perforation within the hernia sac was treated at our hospital. A segmental enterectomy and direct correction of the hernial defect were performed. A perforation in the mesenteric border due to a FB, which seemed to be a toothpick, was identified in the surgical specimen. Nine months after surgery, the patient was without complaints, with adequate healing, and without evidence of hernial recurrence.

To the best of our knowledge, this is the first case of intestinal perforation on an incarcerated incisional hernia, due to an ingested FB, reported in the literature.

Perforated sigmoid colon in the setting of chicken bone ingestion and diverticulitis: A case report

Introduction

Diverticular perforation due to foreign body ingestion is an uncommon but important cause of gastrointestinal tract injury. The aim of this study is to discuss relevant findings seen in diverticulitis caused by foreign bodies and its treatment.

Case presentation

In this report, we present a case of a 30-year-old woman who presented to the emergency department with two days of severe abdominal pain and diarrhea. Computed tomography of the patient's abdomen and pelvis revealed micro-perforations of the sigmoid colon with pneumoperitoneum and an intraluminal foreign body. She subsequently underwent an exploratory laparotomy with sigmoid resection and end-to-end anastomosis due to acute diverticulitis complicated by feculent peritonitis. Gross examination of the excised specimen revealed two large perforations and an intraluminal chicken bone. After a six-day hospitalization, the patient was discharged with an excellent prognosis.

Discussion and conclusion

Prompt radiological evaluation and classification of the degree of diverticulitis using the Hinchey classification system in this patient helped guide definitive treatment. Usage of this classification scheme in foreign body diverticulitis is valuable in determining whether a surgical or non-surgical approach is necessary.

Hepatic abscess caused by esophageal foreign body misdiagnosed as cystadenocarcinoma by magnetic resonance imaging: A case report

BACKGROUND

Foreign bodies stuck in the throat and esophagus can be discharged through the digestive tract. Esophageal-lodged foreign bodies can cause secondary injury or detrimental response, with hepatic abscess being one such, albeit rare, outcome. Review and discussion of the few case reports on such instances will help to improve the overall understanding of such conditions and aid in differential diagnosis to improve patient outcome.

CASE SUMMARY

A 51-year-old female patient with pre-existing diabetes visited our hospital following a 15-d experience of chills and fever. Both plain and enhanced magnetic resonance imaging and color Doppler ultrasound examination of the liver and gallbladder revealed a space-occupying lesion in the caudate lobe of the liver (7.8 cm × 6.0 cm × 5.0 cm). Initially, a malignant tumor was suspected, but differential diagnosis was unable to exclude the possibility of hepatic abscess. Conservative anti-infection therapy produced a less than ideal outcome. Additional examination by hepatobiliary imaging with computed tomography suggested a foreign body present in the upper abdomen and hepatic abscess, and subsequent endoscopy revealed a sinus tract in the anterior wall of the duodenal bulb. Therefore, surgery was performed to remove the object (fishbone) and drain the abscess. After a 2-wk uneventful recovery, the patient was discharged. The final diagnosis was foreign body-induced hepatic abscess of the caudate lobe.

CONCLUSION

Differential diagnosis is important for hepatic masses, and systematic examination and physician awareness can aid in diagnosing and curing such rare conditions.