A bizarre foreign body in the appendix: A case report

Acute appendicitis induced by bone fragment ingestion: A pediatrics case report

Acute appendicitis is an ordinary surgical emergency, typically attributed to luminal obstruction by fecaliths or lymphoid hyperplasia. However, ingested foreign bodies as an etiology are rare but increasingly recognized, particularly in pediatric patients. We present the case of a 9-year-old male patient who presented to the emergency department with symptoms consistent with acute appendicitis. Further investigation revealed the presence of a bone fragment within the appendix, leading to acute inflammation. Foreign body ingestion should be considered in pediatric patients with acute appendicitis. This case report underscores the importance of comprehensive clinical evaluation and appropriate diagnostic imaging modalities in guiding optimal treatment strategies.

A rare case of cecal foreign body leading to cecal perforation in 12-year-old child: a clinical case report and review of literature

Introduction and importance

Cecal foreign bodies are uncommon causes of acute abdomen, and their presentation can often mimic acute appendicitis (AA), making it challenging to diagnose. The authors present the case of a 12-year-old male from Ethiopia who initially presented with symptoms suggestive of AA. However, during surgery, the authors found a multiple magnetic fields result in perforation. This case highlights the importance of considering unusual etiologies.

Case presentation

A 12-year-old boy with AA associated with anorexia, nausea, and low-grade fever was referred from a private clinic. Otherwise, no history of recent respiratory infection and diarrhea, and was previously in good health. The patient did not report any history of a foreign body (FB), even to his own family, and, except for himself, no one was aware of the ingested FB. The work has been reported in line with the Surgical CAse REport (SCARE) 2023 criteria.

Discussion

In this case, the authors experienced multiple magnetic FB in the cecum, which were not observed on ultrasound (U/S). However, this case closely resembled appendicitis. U/S can aid in differentiation. However, it may not always identify the underlying etiology, specifically in a resource-limited setting.

Conclusion

Based on the patient's presentation, AA was diagnosed and emergency surgery was presumed to be inflamed. However, three magnetic FB were the underlying cause of the presentation, which created pressure on the cecal wall, and the authors successfully performed surgical management. This case reminds us of uncommon etiologies, such as magnets in patients with symptoms of appendicitis. This underscores the importance of an open-minded approach to unexpected findings during surgery.

Appendiceal Foreign Bodies in Adults: A Systematic Review of Case Reports

Adults can accidentally swallow foreign bodies (FBs) with food. In rare occasions, these can lodge in the appendix lumen causing inflammation. This is known as foreign body appendicitis. We conducted this study to review different types and management of appendiceal FBs. A comprehensive search on PubMed, MEDLINE, Embase, Cochrane Library and Google Scholar was performed to detect appropriate case reports for this review. Case reports eligible for this review included patients above 18 years of age with all types of FB ingestion causing appendicitis. A total of 64 case reports were deemed to be eligible for inclusion in this systematic review. The patient mean age was 44.3 ± 16.7 years (range, 18-77). Twenty-four foreign bodies were identified in the adult appendix. They were mainly lead shot pellet, fishbone, dental crown or filling, toothpick, and others. Forty-two percent of the included patients presented with classic appendicitis pain, while 17% were asymptomatic. Moreover, the appendix was perforated in 11 patients. Regarding modalities used for diagnosis, computed tomography (CT) scans confirmed the presence of FBs in 59% of cases while X-ray only managed to detect 30%. Almost all of the cases (91%) were treated surgically with appendicectomy and only six were managed conservatively. Overall, lead shot pellets were the most common foreign body found. Fishbone and toothpick accounted for most of the perforated appendix cases. This study concludes that prophylactic appendicectomy is recommended for the management of foreign bodies detected in the appendix, even if the patient is asymptomatic.

Previous Foreign Body Ingestion in the Appendix Causing Acute Appendicitis: A Case Report

Acute appendicitis due to a foreign body is a very rare condition with an incidence of 0.0005% of all appendicitis cases and among all age groups. It is one of the atypical cases of appendicitis, and it is a rare condition commonly asymptomatic; there is a period of time between ingestion of the body and appendicitis. A 14-year-old female patient presented to the emergency room with right lower quadrant colicky pain. Moreover, it was progressive with six hours duration, preceded by loss of appetite. It was associated with nausea, non-projectile vomiting, and diarrhea. By taking the past medical history, the patient had a history of multiple times of foreign ingestions when she was younger. On examination, the patient appeared ill, and was vitally stable. On palpation, the patient had a right lower quadrant tenderness. The patient had positive pointing, rebound, Rovsing, and psoas signs. Full labs were done. Abdominal x-ray revealed a radiopaque metallic body in the right lower quadrant. By ultrasound, there was a minimal free fluid collection in the pelvis. Intraoperatively, the appendix looked hyperemic. Appendectomy was performed, and a needle was extracted from the appendix. Furthermore, the histopathology revealed an early inflamed appendix. Foreign body-causing appendicitis is a rare condition. We need to investigate suspected cases carefully because the presentation is atypical, and sometimes the patients are asymptomatic.

A Bizarre Cause of Acute Appendicitis in a Pediatric Patient: An Ingested Tooth

(1) Background: Among all possible causes, foreign bodies are the rarest cause of appendicitis in the pediatric population. In the majority of cases, ingested foreign bodies pass through the gastrointestinal tract without causing symptoms. However, those foreign bodies that pass through the lumen of the vermiform appendix cannot re-enter the colon and may cause acute appendicitis. So far, various foreign bodies have been described to enter the appendix and cause acute appendicitis, such as seeds, needles, toothpicks, plant material, or even hair. Tooth or dental implants as a cause of acute appendicitis have been described in only a few cases. To our knowledge, this is the first described case of the tooth causing acute appendicitis in the pediatric population. (2) Case presentation: A 14-year-old male patient presented to the emergency department complaining of pain in the right lower quadrant of the abdomen and vomiting that persisted for approximately 24 h. Until then, the patient was healthy and had no concomitant diseases. Physical examination revealed guarding and tenderness in the right lower abdominal quadrant. The white blood cell count was 17.1 × 109/L with a neutrophil count of 91.1% and a C-reactive protein of 39.3 mg/dL. Ultrasonography of the abdomen revealed a thickened, inflamed appendix with a diameter of 11 mm and free periappendicular fluid. A 9 × 6 mm foreign body at the base of the appendix was visualized. The patient was diagnosed with acute appendicitis, and an emergency laparoscopic appendectomy was performed on the same day. Intraoperatively, gangrenous appendicitis was noted and removed without complications. Upon examination of the removed specimen, it was determined that the patient's appendicitis had been caused by an ingested tooth. As it later turned out, the patient had broken a lateral incisor while playing sports the day before admission without knowing that he had swallowed it. The patient recovered well and was discharged the day after surgery. (3) Conclusion: Although an extremely rare event, acute appendicitis can be caused by a swallowed tooth. This case highlights the importance of a thorough history in pediatric patients who present to the emergency department with suspected acute appendicitis to determine if there is a precipitating event that may have caused acute appendicitis.

Bullet Appendicitis: An Unusual Cause to a Rather Straight-Forward Diagnosis

A 19-year-old male patient presented to the emergency department (ED) with pain in the right iliac fossa. Computed tomography (CT) scan of the abdomen and pelvis revealed signs of acute appendicitis, as a result of a metallic foreign body beyond the appendiceal orifice. Upon further questioning, the patient gave a history of ball bearing (BB) gun bullet ingestion in the past. Although rare, foreign body appendicitis occurs. A radiologist should be mindful to reporting such cases especially bizarre foreign bodies for example bullets as it may warrant psychiatric consultation or alter surgical management.

Foreign Body Ingestion Followed by Appendiceal Perforation

Background

Foreign body ingestion is very common among specific groups, especially children. However, appendicitis and perforated appendix caused by a foreign body is rare. Case summary. A 40-year-old female presented with abdominal pain in the right lower quadrant of 10 days duration after accidentally ingesting a drilling bit during a dental procedure. She had right iliac fossa tenderness on physical examination. X-ray showed a pointed long metal object in the right lower quadrant. A contrast-enhanced computed tomography scan of the abdomen revealed a pointed metal object in the pelvis with inconclusive location. Diagnostic laparoscopy showed an inflamed appendix with the tip of the metal object perforating it. Appendectomy was performed. Histopathology showed an inflamed appendix.

Conclusion

Foreign bodies that cause appendicitis are rare. However, they may become lodged at any site of the gastrointestinal tract and cause inflammation or perforation. This is a bizarre case of foreign body-induced appendicitis with perforation.

Unusual cause of appendicitis. A case report of acute appendicitis caused by needle ingestion

INTRODUCTION

Appendicitis is an acute inflammatory process. The purpose of this report is to describe an unusual case of acute appendicitis in adult caused by accidental ingestion of a needle, and treated with appendectomy.

PRESENTATION OF CASE

A 64 year-old white woman, seamstress, was admitted with abdominal pain complaints. Plain radiograph and CT scan showed metal density suggesting a foreign body in the lower right abdomen. A diagnostic laparoscopic procedure identified a perforated appendicitis due to a needle perforation. Laparoscopic appendicectomy and foreign body removal were performed.

DISCUSSION

Acute appendicitis due foreign body ingestion is extremely rare. Laparoscopy was the chosen access once it was more suitable for inventory of the gastrointestinal tract and help avoiding harm of the medical team during hand maneuvers of open access surgery.

CONCLUSION

Foreign body ingestion should be remembered as an unusual differential diagnosis of acute appendicitis.

A nail in the appendix, accidental discovery on an asymptomatic patient

Inadvertent ingestion of foreign bodies is a common condition within clinical practice. It rarely produces any symptoms. The diagnosis is difficult since most patients do not recall having swallowed any object. Needles, pins, keys, nails and bones are among the most commonly ingested foreign bodies. Severe complications are uncommon, but if present they can put patients’ lives at risk. Although extremely rare, the ingested foreign body may end lodging in the appendix, posing a challenge for the clinical team. Once the exact location of the object is confirmed, the extraction of the foreign object must be performed to avoid complications. The present report describes a case of a young adult patient, who presented to the emergency room after a routine medical examination. A 30 mm metallic nail was discovered in the tip of the appendix. After a failed endoscopic approach an appendectomy was performed, and the patient underwent a complete recovery.

A Pediatric Foreign Body Appendicitis Can Cause a Pitfall in Imaging

Although foreign body (FB) ingestion is common in childhood, most cases do not have any clinical significance. Radiologic evaluation is crucial to determine the exact location of a persistent foreign body because it dictates the therapeutic approach. In this case report, we present a child with appendiceal perforation caused by a FB and emphasize pitfalls in preoperative imaging assessment. A 3-year-old boy presented with subtle abdominal pain duration for three months. The preoperative imaging examinations were consistent with an intraluminal metallic pin. However, the operative findings and postoperative pathological examination showed that the pin perforated the appendiceal wall, causing chronic inflammatory changes with an omental reaction around the extraluminal part of the pin. The patient underwent appendectomy with an uneventful course. Foreign body is a rare cause of appendiceal perforation with resultant appendicitis. Imaging may reveal some clues regarding the location, but the interpretation of radiologic data could be quite challenging.

Ingested foreign body mimicking acute appendicitis

INTRODUCTION

The incidence of acute appendicitis is approximately 250,000 cases per year in the United States with a lifetime risk of 7% (Gupta & Dupuy, 1997). However, despite strongly associated clinical signs, diagnostic accuracy based on history and physical exam alone is only 70% (Jess et al., 1981). This is in large part due to the multitude of mimics found in the differential diagnosis of appendicitis. As a result highly sensitive imaging such as computed tomography scan has become standard of care.

PRESENTATION OF CASE

We present a case of an otherwise healthy 20year old male presenting to the emergency department with acute onset of right lower quadrant pain and leukocytosis consistent with a diagnosis of appendicitis. Ultrasonography was grossly negative as was a computed tomography scan. Given the peritoneal nature of the patient's abdominal exam, general surgery was consulted. The patient was taken for exploratory laparoscopy where a long, thin, metallic foreign body was found to have perforated the small intestine.

DISCUSSION

Discussion includes a literature review of computed tomography negative appendicitis, as well as the frequency of foreign body mimicking appendicitis. This case demonstrates the importance of the clinical exam even in the face of negative highly sensitive imaging modalities.

CONCLUSION

In conclusion, there are several mimics of acute appendicitis and we present an unusual case of a foreign body mimicking this disorder in a young person. Highly sensitive imaging coupled with history and physical examination remains the standard of care for diagnosing appendicitis; however, clinical acumen must be utilized to formulate a broad differential.

Appendiceal foreign body in an infant

RATIONALE FOR THIS CASE REPORT

Many children are hospitalized because of foreign body ingestion. In such circumstances, the gastroenterologist must consider the timing of ingestion; the size, type, and location of the object ingested; and the patient's symptoms. But appendiceal foreign body in infant is very rare.

PATIENT CONCERNS

A 12-month-old boy visited because of swallowing small objects 2 weeks ago. Three small beads were found in the right lower quadrant on abdominal radiography. A 7-year-old boy was admitted for treatment of appendiceal foreign body, which was detected by accident 3 months ago.

DIAGNOSES, INTERVENTIONS, AND OUTCOMES

A 7-year-old boy had abdominal pain and underwent immediate appendectomy. However, the 12-month-old child was asymptomatic, which led to deliberation in regard to wait time for an appendectomy in younger children with asymptomatic appendiceal foreign body. He underwent prophylactic appendectomy after 2 months.

MAIN LESSONS

An appendiceal foreign body is very rare in infant and there are currently no treatment guidelines. We report 2 cases of appendiceal foreign body including infant who gave us difficult decisions.

Endoscopic Management of Foreign Bodies in the Gastrointestinal Tract: A Review of the Literature

Foreign body ingestion is a common diagnosis that presents in emergency departments throughout the world. Distinct foreign bodies predispose to particular locations of impaction in the gastrointestinal tract, commonly meat boluses in the esophagus above a preexisting esophageal stricture or ring in adults and coins in children. Several other groups are at high risk of foreign body impaction, mentally handicapped individuals or those with psychiatric illness, abusers of drugs or alcohol, and the geriatric population. Patients with foreign body ingestion typically present with odynophagia, dysphagia, sensation of having an object stuck, chest pain, and nausea/vomiting. The majority of foreign bodies pass through the digestive system spontaneously without causing any harm, symptoms, or necessitating any further intervention. A well-documented clinical history and thorough physical exam is critical in making the diagnosis, if additional modalities are needed, a CT scan and diagnostic endoscopy are generally the preferred modalities. Various tools can be used to remove foreign bodies, and endoscopic treatment is safe and effective if performed by a skilled endoscopist.

Foreign Bodies Ingestion in Children: Experience of 61 Cases in a Pediatric Gastroenterology Unit from Romania

The ingestion of foreign bodies is a worldwide pediatric pathology. We assessed the clinical, endoscopic, and therapeutic aspects of this condition in a pediatric gastroenterology unit. We reviewed 61 patients (median age of 3.25 ± 4.7 years). The most frequently ingested objects were coins (26.23%), unidentified metal objects (13.11%), bones (8.19%), batteries, and buttons (6.55%). The clinical features we encountered included abdominal pain (55.73%), vomiting (34.42%), and asymptomatic children (29.5%). Routine X-ray examination enabled finding the foreign body in 42 of the cases. An esophagogastroduodenoscopy was performed within 24-72 hours. 25 cases resulted in a negative endoscopy (40.98%), 19 objects (31.14%) were removed using a polypectomy snare, and extraction failure occurred in 17 patients (27.86%). 28 foreign bodies were passed without incidents; in 14 cases, the swallowed objects were never found. In one case, a battery was stuck in the esophageal folds and led to tracheal-esophageal fistula and bronchopneumonia and later to esophageal stenosis. We report a large proportion of foreign bodies that could not be identified or removed due to lack of early endoscopy and poor technical settings. Batteries and sharp objects lead to severe complications and preschool-age children are at high risk for such events.

Acute appendicitis caused by foreign body ingestion

Foreign bodies usually do not cause complications and pass through the gastrointestinal tract spontaneously. Usually endoscopic intervention is recommended within 24 hours. Cases of acute appendicitis caused by foreign bodies are very rare. In our case, we experienced successful endoscopic and surgical treatment of a patient with ingestion of razor blade and some unrecognizable foreign bodies. A 22-year-old soldier was admitted with a small quantity of hematemesis and epigastric pain. We performed emergent endoscopy and successfully removed several foreign bodies. After 17 days, we performed appendectomy to remove the remaining foreign body and to relieve the symptoms. There is no doubt that endoscopic intervention is definitely useful method to remove foreign bodies. If there is no spontaneous drainage of the foreign body from the appendix, an appendectomy must be considered to remove the foreign body and prevent surgical complications such as appendicitis, periappendiceal abscess, and perforation.

Acute Appendicitis as Complication of Colon Transit Time Study; A Case Report

Colon transit time study with radio opaque markers is a simple method for assessment of colon motility disorder in patients with chronic idiopathic constipation. We report a case of acute appendicitis that was induced by impaction of radio opaque markers after colon transit time study. We think that this case report is first significant complication of colon transit time study until now.

An Unusual Cause of Abdominal Pain: Three Lead Pellets within the Appendix Vermiformis

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.

Fishbone-induced perforated appendicitis

We review the literature and describe a case of fishbone-induced appendicitis. A 63-year-old man presented with abdominal pain. Work up including a focused history and imaging revealed fishbone-induced perforated appendicitis. The patient was managed safely and successfully with laparoscopic removal of the foreign body and appendectomy.