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Chung YC, Lekamalage B, Rajagopalan A, Arachchi A. First Reported Case of Lesser Sac Empyema Secondary to Foreign Body Perforation. Cureus 2023; 15:e47186. [PMID: 38021889 PMCID: PMC10652229 DOI: 10.7759/cureus.47186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2023] [Indexed: 12/01/2023] Open
Abstract
This is the first reported case of lesser sac empyema secondary to a foreign body perforation in the posterior stomach. Although PubMed and Google Scholar search reports cases of lesser sac empyema alone and foreign body penetrations, there are currently no reported cases of a lesser sac abscess secondary to a foreign body. Patients with a lesser sac empyema present atypically with an insidious onset. The lesser sac should be examined in patients with peritonitis without a clear source. A 48-year-old female presented to the emergency department with acute onset epigastric pain. The patient was tender in the epigastrium and left upper quadrant with associated guarding. The patient had elevated white cell count and C-reactive protein, with a computed tomography scan identifying a foreign body posterior gastric wall perforation. The patient was managed with endoscopic drainage of the lesser sac empyema and surgical washout of the abdomen. Foreign bodies are investigated using different imaging modalities, with computed tomography being able to further evaluate the size, shape, and complications. Intra-abdominal collections can be managed through three different methods: percutaneous drainage, endoscopic drainage, and surgery. Patients with peritonitis would require a laparoscopic or open surgical washout of the abdomen and inspection of the lesser sac would be necessary if no obvious source is identified. Foreign body ingestion requires careful history taking and assessment. Patients with lesser sac empyema present atypically, and this can lead to delayed surgical referral and management. Contained intra-abdominal collections can be drained percutaneously or endoscopically.
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Affiliation(s)
| | - Binura Lekamalage
- Department of General Surgery, Tauranga Hospital, Bay of Plenty, NZL
| | | | - Asiri Arachchi
- Department of Colorectal Surgery, Monash Health, Dandenong, AUS
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Tepelidis C, Fotiadis P, Permekerlis A, Karastergiou T, Kouridakis P. Descending Colon Perforation Due to Ingestion of Foreign Body. Cureus 2023; 15:e47479. [PMID: 38022202 PMCID: PMC10663047 DOI: 10.7759/cureus.47479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2023] [Indexed: 12/01/2023] Open
Abstract
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.
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Affiliation(s)
- Christos Tepelidis
- 2nd Surgical Department, 424 General Military Hospital, Thessaloniki, GRC
| | | | | | - Trigona Karastergiou
- Surgery, General Hospital of Thessaloniki "George Papanikolaou", Thessaloniki, GRC
| | - Petros Kouridakis
- 2nd Surgical Department, 424 General Military Hospital, Thessaloniki, GRC
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Mohanty D, Dugar D, Waliya A. A Right-Angled Thorn in the Bowel: A Curious Case of Small Bowel Perforation. Cureus 2023; 15:e44068. [PMID: 37750116 PMCID: PMC10517881 DOI: 10.7759/cureus.44068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 09/27/2023] Open
Abstract
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.
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Affiliation(s)
- Debajyoti Mohanty
- General Surgery, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Dharmendra Dugar
- General Surgery, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Asish Waliya
- General Surgery, All India Institute of Medical Sciences, Raipur, Raipur, IND
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Swedan T, Morjan M, Jarjanazi M, Martini N, Ismail AA, Awad H, Benbash S. Delayed ileal perforation following lollipop-stick ingestion in a two year old. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Rajaguru K, Sheong SC. Case report on a rare cause of silent duodenal perforation. Int J Surg Case Rep 2020; 76:320-323. [PMID: 33065491 PMCID: PMC7567171 DOI: 10.1016/j.ijscr.2020.09.184] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/27/2020] [Accepted: 09/27/2020] [Indexed: 11/15/2022] Open
Abstract
We describe a rare case of duodenal perforation related to foreign body ingestion which has rarely been reported in the literature. Foreign body perforations were uncommon and often missed in view of its atypical and latent presentation. Early multiplanar reformatting CT images help in identifying the cause and also to locate the foreign body in most of the patients, thus making it an important tool for preoperative diagnosis which assists in surgical planning. Though the majority of patients will require an exploratory laparotomy, minimally invasive procedures can be attempted in stable patients similar to this case.
Introduction Foreign body ingestion is a common clinical scenario encountered in clinical practice. Perforations related to foreign bodies are rare (<1%) but can present as a serious element in Emergency surgery. The most common site of perforations are angulated areas like ileocecal valve, sigmoid colon and duodeno-jejunal flexure and small bowel. We describe a rare case of duodenal perforation related to foreign body ingestion which has rarely been reported in the literature. Case presentation and management This case report describes the presentation and management of a 65 year old male who presented with septic shock without symptoms and signs of an acute abdomen. Imaging revealed a sealed foreign body perforation in the first part of duodenum with a localized abscess. The abscess cavity was drained and the foreign body (fish bone) was removed laparoscopically. Conclusion Foreign body perforations were often missed in view of its atypical and latent presentation with the history of foreign body ingestion is rare. Early multiplanar reformatting CT images help in identifying the cause and also to locate the foreign body in most of the patients, thus making it an important tool for preoperative diagnosis which assists in surgical planning. Though the majority of patients will require an exploratory laparotomy, minimally invasive procedures can be attempted in stable patients similar to this case.
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Affiliation(s)
- Kishore Rajaguru
- Ng Teng Fong General Hospital, Department of General Surgery, National University Health System, Singapore.
| | - Seow Choon Sheong
- Ng Teng Fong General Hospital, Department of General Surgery, National University Health System, Singapore
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Fish Bone Causing Perforation of the Intestine and Meckel's Diverticulum. Case Rep Surg 2020; 2020:8887603. [PMID: 33014507 PMCID: PMC7525315 DOI: 10.1155/2020/8887603] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/14/2020] [Accepted: 09/09/2020] [Indexed: 01/29/2023] Open
Abstract
Perforation of small bowel due to ingested fish bone is rare, the most common site is ileum and occasionally, it can involve the appendix and/or Meckel diverticulum. We report six patients who, developed bowel perforation after fish bone ingestion, four of them found to have rent in the ileum and two through Meckel's diverticulum and presented with abdominal pain and localized peritonitis. All underwent surgical exploration and removal of the fish bone and closure of the small intestine/excision of the diverticulum. Foreign body ingestion should be kept in mind in suspicious cases, and laparoscopy is very important to diagnose such rare cases as they may commonly be missed by imaging.
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E Silva GS, Gomes NBN, Pacheco EO, Bezerra FMR, Nunes RB, Mcphee HL, Torres US, D'Ippolito G. Emergency CT of abdominal complications of ingested fish bones: what not to miss. Emerg Radiol 2020; 28:165-170. [PMID: 32504281 DOI: 10.1007/s10140-020-01800-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 05/25/2020] [Indexed: 11/30/2022]
Abstract
Fish bones are the most commonly ingested structures and the most common cause of foreign body perforation of the gastrointestinal tract (GIT). Clinical presentation of foreign body GIT perforation is nonspecific, in many cases with clinical signs of acute abdomen, which can mimic appendicitis, diverticulitis, ulcer peptic disease, and other common inflammatory conditions. Besides, patients commonly do not refer that a fish bone was swallowed. Since this condition is usually not suspected by referring physicians of the emergency department (ED), radiologists play a key role in this diagnosis; the spectrum of these imaging features must be known in order to be accurately reported in the ED.
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Affiliation(s)
- Gabriella Souza E Silva
- Grupo Fleury, Rua Cincinato Braga, 282, Bela Vista, São Paulo, SP, 01333-010, Brazil
- Hospital São Paulo, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Natália Borges Nunes Gomes
- Grupo Fleury, Rua Cincinato Braga, 282, Bela Vista, São Paulo, SP, 01333-010, Brazil
- Hospital São Paulo, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Eduardo Oliveira Pacheco
- Grupo Fleury, Rua Cincinato Braga, 282, Bela Vista, São Paulo, SP, 01333-010, Brazil
- Hospital São Paulo, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | | | - Ulysses S Torres
- Grupo Fleury, Rua Cincinato Braga, 282, Bela Vista, São Paulo, SP, 01333-010, Brazil.
- Hospital São Paulo, Universidade Federal de São Paulo, São Paulo, Brazil.
| | - Giuseppe D'Ippolito
- Grupo Fleury, Rua Cincinato Braga, 282, Bela Vista, São Paulo, SP, 01333-010, Brazil
- Hospital São Paulo, Universidade Federal de São Paulo, São Paulo, Brazil
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Kao EN, Liao KH, Chen TW, Chan DC, Yu JC. Colon perforation caused by swallowing a shrimp leg: A case report. Int J Surg Case Rep 2018; 52:114-116. [PMID: 30342390 PMCID: PMC6197384 DOI: 10.1016/j.ijscr.2018.09.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 09/13/2018] [Accepted: 09/27/2018] [Indexed: 11/29/2022] Open
Abstract
Colon perforation caused by swallowing a shrimp leg is the first reported case currently. Chronic perforation of colon may not need emergent surgery. Laparoscopic drainage and removal of shrimp leg is effect treatment to diminish hospital days.
Introduction Ingestion of a foreign body rarely results in perforation of the gastrointestinal tract. Foreign bodies such as dentures, fish bones, chicken bones, toothpicks and cocktail sticks have been known to cause bowel perforation; however, bowel perforation caused by shrimp leg has not been reported so far. Presentation of case We report a case of a 69-years-old man who presented with a 4-months epigastric pain. Laboratory data revealed inflammation at the first hospital visit. Computed tomography revealed a hypodense lesion containing a hyperdense foreign body in the abdomen. Intra-abdominal abscess caused by foreign body perforation was diagnosed. Discussion An increased incidence of perforation has been reported in association with Meckel’s diverticulum, the appendix, and diverticular disease. The abdominal abscess in this case was located beside the diverticulum of transverse colon, so the perforation most likely occurred in the diverticulum of transverse colon. Conclusion Perforation of colon by shrimp leg is very rare and not reported currently. Although some cases have been successfully treated chronic foreign-body perforation with abscess by using antibiotics alone, typical treatments remains surgical drainage of the abscess and removal of foreign body.
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Affiliation(s)
- En-Nung Kao
- Division of General Surgery, Department of Surgery, Taichung Armed Forces General Hospital, No.348, Sec.2, Chungshan Rd., Taiping Dist., Taichung City 41152, Taiwan; Division of General Surgery, Department of Surgery, Tri-Services General Hospital, National Defense Medical Center, No.325, Sec.2, Chenggong Rd., Neihu District, Taipei City 114, Taiwan.
| | - Kuo-Hsiu Liao
- Division of General Surgery, Department of Surgery, Tri-Services General Hospital, National Defense Medical Center, No.325, Sec.2, Chenggong Rd., Neihu District, Taipei City 114, Taiwan.
| | - Teng-Wei Chen
- Division of General Surgery, Department of Surgery, Tri-Services General Hospital, National Defense Medical Center, No.325, Sec.2, Chenggong Rd., Neihu District, Taipei City 114, Taiwan.
| | - De-Chuan Chan
- Division of General Surgery, Department of Surgery, Tri-Services General Hospital, National Defense Medical Center, No.325, Sec.2, Chenggong Rd., Neihu District, Taipei City 114, Taiwan.
| | - Jyh-Cherng Yu
- Division of General Surgery, Department of Surgery, Tri-Services General Hospital, National Defense Medical Center, No.325, Sec.2, Chenggong Rd., Neihu District, Taipei City 114, Taiwan.
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Paixão TSA, Leão RV, de Souza Maciel Rocha Horvat N, Viana PCC, Da Costa Leite C, de Azambuja RL, Damasceno RS, Ortega CD, de Menezes MR, Cerri GG. Abdominal manifestations of fishbone perforation: a pictorial essay. Abdom Radiol (NY) 2017; 42:1087-1095. [PMID: 27717979 DOI: 10.1007/s00261-016-0939-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE The present article provides an overview of the spectrum of abdominal presentations of fishbone (FB) ingestion and its complications. METHODS In image data from 9 patients, FB perforations were found in different levels of the gastrointestinal tract (GIT), including duodenal, jejunal, and sigmoid perforations; in 4 asymptomatic patients, FBs were observed in the mesentery, falciform ligament, and intestinal bowel. RESULTS The main imaging features of FB perforation were focal gastric or intestinal wall thickening, fat stranding, bowel obstruction, ascites, localized pneumoperitoneum, intra-abdominal abscess, liver abscess, and a linear hyperdense structure in the abdominal cavity in the GIT or within a parenchymal organ often surrounded by inflammatory changes. Free pneumoperitoneum was rare. CONCLUSION Although in most cases, a FB does not cause any serious complications, an inflammatory process and complications may occur when it perforates the stomach or bowel loops. Radiologists need to be aware of the possibility of FB perforation, especially in high-risk patients, because it is not always considered in the differential diagnosis by referring physicians and can mimic other inflammatory conditions and tumoral lesions.
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Affiliation(s)
- Tassia Soraya Araujo Paixão
- Radiology Department, Hospital Sirio-Libanes, Rua Dona Adma Jafet, 115-Bela Vista, São Paulo, SP, 01308-050, Brazil.
| | - Renata Vidal Leão
- Radiology Department, Hospital Sirio-Libanes, Rua Dona Adma Jafet, 115-Bela Vista, São Paulo, SP, 01308-050, Brazil
| | | | | | - Claudia Da Costa Leite
- Radiology Department, Hospital Sirio-Libanes, Rua Dona Adma Jafet, 115-Bela Vista, São Paulo, SP, 01308-050, Brazil
| | - Rodrigo Lautert de Azambuja
- Radiology Department, Hospital Sirio-Libanes, Rua Dona Adma Jafet, 115-Bela Vista, São Paulo, SP, 01308-050, Brazil
| | - Rodrigo Sanford Damasceno
- Radiology Department, Hospital Sirio-Libanes, Rua Dona Adma Jafet, 115-Bela Vista, São Paulo, SP, 01308-050, Brazil
| | - Cinthia Denise Ortega
- Radiology Department, Hospital Sirio-Libanes, Rua Dona Adma Jafet, 115-Bela Vista, São Paulo, SP, 01308-050, Brazil
| | - Marcos Roberto de Menezes
- Radiology Department, Hospital Sirio-Libanes, Rua Dona Adma Jafet, 115-Bela Vista, São Paulo, SP, 01308-050, Brazil
| | - Giovanni Guido Cerri
- Radiology Department, Hospital Sirio-Libanes, Rua Dona Adma Jafet, 115-Bela Vista, São Paulo, SP, 01308-050, Brazil
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Kim JS, Cha JM, Kwak MS, Yoon JY, Jeon JW, Shin HP, Joo KR, Lee JI, Kim HY. Small Bowel Perforation Caused by Press-through Package. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2017; 70:261-264. [DOI: 10.4166/kjg.2017.70.5.261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Jung Seok Kim
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jae Myung Cha
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Min Seob Kwak
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jin Young Yoon
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jung Won Jeon
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Hyun Phil Shin
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Kwang Ro Joo
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Joung Il Lee
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
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Nicolodi GC, Trippia CR, Caboclo MFFS, de Castro FG, Miller WP, de Lima RR, Tazima L, Geraldo J. Intestinal perforation by an ingested foreign body. Radiol Bras 2016; 49:295-299. [PMID: 27818542 PMCID: PMC5094817 DOI: 10.1590/0100-3984.2015.0127] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To identify the computed tomography findings suggestive of intestinal
perforation by an ingested foreign body. Materials and Methods This was a retrospective study of four cases of surgically proven intestinal
perforation by a foreign body, comparing the computed tomography findings
with those described in the literature. Results None of the patients reported having ingested a foreign body, all were over
60 years of age, three of the four patients used a dental prosthesis, and
all of the foreign bodies were elongated and sharp. In all four patients,
there were findings indicative of acute abdomen. None of the foreign bodies
were identified on conventional X-rays. The computed tomography findings
suggestive of perforation were thickening of the intestinal walls (in all
four cases), increased density of mesenteric fat (in all four cases),
identification of the foreign body passing through the intestinal wall (in
three cases), and gas in the peritoneal cavity (in one case). Conclusion In cases of foreign body ingestion, intestinal perforation is more common
when the foreign body is elongated and sharp. Although patients typically do
not report having ingested such foreign bodies, the scenario should be
suspected in elderly individuals who use dental prostheses. A computed
tomography scan can detect foreign bodies, locate perforations, and guide
treatment. The findings that suggest perforation are thickening of the
intestinal walls, increased mesenteric fat density, and, less frequently,
gas in the peritoneal cavity, often restricted to the point of
perforation.
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Affiliation(s)
| | | | | | | | - Wagner Peitl Miller
- MD, Radiology Resident at Hospital São Vicente - Funef, Curitiba, PR, Brazil
| | | | - Leandro Tazima
- MD, Radiology Resident at Hospital São Vicente - Funef, Curitiba, PR, Brazil
| | - Jamylle Geraldo
- MD, Radiology Resident at Hospital São Vicente - Funef, Curitiba, PR, Brazil
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Coulier B, Rubay R, Van den Broeck S, Azar AR, Maldague P, Mailleux P, Lismonde Y, Bueres I. Perforation of the gastrointestinal tract caused by inadvertent ingestion of blister pill packs: report of two cases diagnosed by MDCT with emphasis on maximal intensity and volume rendering reformations. ACTA ACUST UNITED AC 2016; 39:685-93. [PMID: 24643854 DOI: 10.1007/s00261-014-0120-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
We report two cases of elderly patients presenting with life-threatening complications due to inadvertent accidental ingestion of blister pill packs (BPPs). The first patient presented with obstruction followed by anemia and finally perforation of the small bowel. The second presented with rapidly lethal mediastinitis due to a large perforation of the lower esophagus. The responsible BPPs were identified by multidetector computed tomography and the best result in their characterization was obtained through maximal intensity projections and volume rendering reformations.
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Affiliation(s)
- Bruno Coulier
- Department of Diagnostic Radiology, Clinique St Luc, Rue St Luc 8, Bouge, 5004, Namur, Belgium,
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[Bowel perforations due to fish bones: rare and curious]. Semergen 2012; 39:117-8. [PMID: 23452541 DOI: 10.1016/j.semerg.2012.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 07/19/2012] [Indexed: 01/15/2023]
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["Atypical" anemia in a geriatric patient]. Z Gerontol Geriatr 2012; 45:186-8. [PMID: 22451306 DOI: 10.1007/s00391-012-0328-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
A gastroenterologic examination was performed on an 83-year-old woman due to unexplained anemia; however, no bleeding site could be identified. Because of the advanced age of the patient, no further diagnostic efforts were made and iron-deficiency anemia was suspected. After 3 weeks, an emergency laparotomy was performed for acute diffuse peritonitis, which was diagnosed as perforation of the jejunum by a wooden foreign body. After extraction of the foreign body and closure of the perforation in the small intestine, healing proceeded without complications.
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Bakhshaeekia A, Hosseini SM, Razmi T, Shamsaeefar A. Bowel perforation by crumpled paper in a patient presenting with acute abdominal pain. Saudi J Gastroenterol 2009; 15:52-4. [PMID: 19568558 PMCID: PMC2702949 DOI: 10.4103/1319-3767.45060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Accepted: 04/21/2008] [Indexed: 11/17/2022] Open
Abstract
Many of the abdominal foreign bodies are due to accidental ingestion. Our objective in this case report is to emphasize the importance of the enquiry about the foreign body in the differential diagnosis of acute abdominal pain. According to our knowledge, this is the first report of bowel perforation caused by paper ingestion. A 14-year-old boy with abdominal pain underwent exploratory laparotomy and was found to have abdominal pus and ileal perforation. A crumpled paper was found at the site of perforation. Postoperative enquiry revealed that the patient had ingested 10 crumpled papers. We highlight that recording the history is an important aspect in the management of patients with acute abdominal pain and that foreign bodies should be included in its differential diagnosis.
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Affiliation(s)
- Alireza Bakhshaeekia
- Department of Pediatric Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed M.V. Hosseini
- Department of Pediatric Surgery, Shiraz University of Medical Sciences, Shiraz, Iran,Address for correspondence: Dr. Seyed M. V. Hosseini, Nemazi Hospital, Shiraz - 71877, Fars - Iran. E-mail:
| | - Tannaz Razmi
- Department of Pediatric Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Shamsaeefar
- Department of Pediatric Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
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Coulier B, Tancredi MH, Ramboux A. Spiral CT and multidetector-row CT diagnosis of perforation of the small intestine caused by ingested foreign bodies. Eur Radiol 2004; 14:1918-25. [PMID: 15378256 DOI: 10.1007/s00330-004-2430-1] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2004] [Revised: 06/11/2004] [Accepted: 06/18/2004] [Indexed: 01/06/2023]
Abstract
The aim of this retrospective study was to emphasize the performances of spiral CT (HCT) and multidetector-row CT (MDCT) as very effective imaging modalities for the diagnosis of intestinal perforations caused by calcified alimentary foreign bodies. Eight sites of perforations of the ileum by ingested foreign bodies were found in seven patients--one patient presenting with two separate sites of perforation. The diagnosis was successfully made by HCT in four patients and MDCT in the remaining three. Involuntarily and generally unconsciously ingested chicken and fish bones were the implicated calcified foreign bodies. The acute clinical presentations were nonspecific, mimicking more common acute abdominal conditions. A thickened intestinal segment (7/8 sites) with localized pneumoperitoneum (4/8 sites), surrounded by fatty infiltration (4/8 sites) and associated with already present or developing obstruction or sub-obstruction (5/7 patients) were the most common CT signs, but the definite diagnosis was clearly made by the identification of the calcified foreign bodies (7/7 patients). In each patient, this identification was only possible thanks to the scrupulous analysis of very thin overlapping reconstructions obtained not only in the perforation sites (6/8 sites), but also through the entire abdomen (2/8 sites). Our report emphasizes the high performances of CTA and MDCT in identifying intestinal perforation caused by calcified alimentary foreign bodies. Moreover, the high specificity of the CT diagnosis made it possible to avoid surgerical exploration in three patients.
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Affiliation(s)
- Bruno Coulier
- Department of Diagnostic Radiology, Clinique St Luc, Rue St Luc 8, Bouge, Namur, Belgium.
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Tomas X, Alos L, Cores E, Pomes J, García-Díez AI, García-Barrionuevo J. Small bowel perforation due to ingested clam valve: imaging findings. Eur Radiol 2004; 15:189-90. [PMID: 15248082 DOI: 10.1007/s00330-004-2400-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2004] [Accepted: 05/03/2004] [Indexed: 11/24/2022]
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Handschin AE, Kadry Z, Selzner M, Müllhaupt B, Renner E, Weber M, Clavien PA. Atypical abdominal pain in a liver transplant recipient. Liver Transpl 2003; 9:444-5. [PMID: 12682900 DOI: 10.1053/jlts.2002.50004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Alexander E Handschin
- Department of Visceral and Transplant Surgery, University Hospital of Zurich, Switzerland
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Rodríguez Hermosa J, Farrés Coll R, Codina Cazador A, Olivet Pujol F, Gironès Vilà J, Roig García J, Blanco Díaz J, Pont Vallés J. Perforaciones intestinales causadas por cuerpos extraños. Cir Esp 2001. [DOI: 10.1016/s0009-739x(01)71792-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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20
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Affiliation(s)
- A A Rasheed
- Department of Radiology, Massachusetts General Hospital and the Harvard Medical School, 15 Parkman St., Boston, MA 02114, USA
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