Unusual presentation of gastric perforation by foreign body: a case report

An unusual and fatal case of upper gastrointestinal perforation and bleeding secondary to foreign body ingestion

We report a fatal case of gastrointestinal perforation and hemorrhage secondary to the ingestion of a foreign body. While engaged in an amateur futsal competition, an apparently healthy young man suddenly collapsed and his respiration ceased. Autopsy revealed a 3-mm circular perforation on the gastric wall fundus with a significant amount of clotted blood within the gastric lumen. On inspection, a foreign body consisting of a bristle-like hair, later identified via electron microscopy to be a cat vibrissa, i.e. a whisker, was found along the perforation margin. Thus, the inadvertent ingestion of fine, sharp objects (even a cat whisker) can lead to gastric perforation and bleeding, which might prove fatal under given circumstances.

Gastric perforation by a foreign body presenting as a pancreatic pseudotumour

INTRODUCTION

Foreign body ingestion rarely causes complications, though it can pose a significant diagnostic challenge. Perforation, particularly of more muscular viscera, can present insidiously with a wide range of differential diagnoses.

PRESENTATION OF CASE

Here we present a case of 75 year-old woman presenting with chest and epigastric pain. Initial imaging suggested a pancreatic lesion. Despite appropriate treatment she deteriorated clinically, and following urgent laparotomy a duck bone fragment was found to have perforated the lesser curvature of the stomach and embedded within the liver causing subhepatic abscess formation and associated inflammation.

DISCUSSION

There are a number of examples of insidious presentations of gastrointestinal perforation. However, we have found only one other case of a perforation presenting as a pancreatic pseudotumour, and ours is the first to have been successfully managed by removal of the foreign body and drainage of the abscess alone.

CONCLUSION

A high level of suspicion is required to make the correct diagnosis in cases such as these where the symptoms are not clear-cut. Thorough review and discussion of imaging prior to surgical treatment is essential to prevent unnecessary intervention.

Gastric Perforation and Phlegmon Formation by Foreign BodyIngestion

This is a case report of foreign body ingestion in a suicide attempt resulting in gastric perforation and phlegmon formation during a subsequent 6 month period that eventually required surgical intervention. The patient had a prolonged course because she did not report a history of foreign body ingestion and the initial evaluating physicians had no suspicion about possible foreign body ingestion and may have missed important findings on physical examination. Gastric perforation by a foreign object may have a slow course rather than presenting acute abdomen. The realization of a proper physical examination in the emergency department is key to an accurate diagnosis.

Liver abscess and pseudotumoral gastric lesion caused by chicken bone perforation: laparoscopic management

The accidental ingestion of a foreign body into the gastrointestinal tract is not uncommon, but the vast majority of foreign bodies pass through the gastrointestinal tract uneventfully within a week. Less than 1% of patients with foreign body ingestion develop complications such as perforation of the gastrointestinal tract. The migration of an ingested foreign body may result in chronic inflammation, a silent clinical course, and radiological features suggestive of a neoplasm. The authors report a case of chicken bone perforation of the gastric wall that leads to hepatic abscess formation and thereafter to submucosal pseudotumor of the gastric wall treated with totally laparoscopic management. Usefulness of endoscopic ultrasonography for a correct diagnosis is also stressed.