A 33-year-old female presented with a 1-day history of migratory right iliac fossae pain which initially began in the periumbilical region. This was associated with nausea, two non-bilious vomits and also a loss of appetite. She denied any urinary symptoms or vaginal discharge. She has no other medical or surgical issues. Examination of the patient showed her to be apyrexial with normal observations. She had some lower abdominal pain which was not too specific. Bloodwork showed a CRP of 165 mg/L with a WCC of 17.5 × 10 9 /L, neutrophil count of 15.1 × 10 9 /L. Beta HCG was negative.As part of her workup, she received a CT KUB which showed a dilated appendix with localized collection and also a metallic foreign body in the base of the appendix or in the caecum (Figs 1,2). We proceeded with diagnostic laparoscopy.She underwent a laparoscopic appendicectomy which showed free pus in the pelvis, right and left iliac fossae. An appendix in the pelvic position was seen to be inflammed and friable, as expected. The appendix was removed and it was bisected postoperatively by the operating surgeon. Surprisingly, we found the foreign body in the base of the appendix covered by faecal matter (Fig. 3) and seemingly causing a mass.The patient recovered well in the postoperative period and recounted a previously swallowed tongue piercing stud which she accidentally swallowed about 3 years ago. This correlated to the

IntroductionPatients with head and neck cancer (HNC) are particularly susceptible to dysphagia and malnutrition. Prophylactic percutaneous endoscopic gastrostomy (PEG) placement is a method used to manage these issues, but practices vary among institutions. At Midcentral District Health Board, patients receiving radiotherapy to the primary and bilateral neck regions routinely undergo prophylactic PEG placement. This study aimed to review the nutritional and PEG‐related outcomes of these patients.MethodsRecords of 49 patients were retrospectively reviewed. Their demographics, tumour and treatment characteristics were recorded. We evaluated patient weight loss, non‐elective hospitalisation, treatment interruption rates, PEG‐related complications, usage, dependency rates and late dysphagia rates.ResultsOropharyngeal cancers were the most common primary site (61.2%), and 83.7% of patients received primary chemoradiotherapy. Mean weight loss at treatment completion was 5.6% ± 4.3 (4.6 kg ± 3.9). The rate of non‐elective hospitalisations was 26.5%, and only 2% of patients had treatment interruptions. Peristomal infection was the most frequent PEG complication (20.4%). No PEG‐related mortality was reported. Median duration of PEG dependency was 97 days (14–388 days). Two patients remained permanently dependent at 3 years due to grade 3 dysphagia, and six patients experienced grade ≥2 late dysphagia.ConclusionOur study showed that prophylactic PEG tube placement was relatively safe, with a high utilisation rate and low long‐term dependence on PEG tubes after treatment completion. However, complications related to their use should be addressed through a multidisciplinary approach, with careful assessment by clinicians. The weight loss and hospitalisation rates observed were consistent with earlier studies that utilised prophylactic PEG tubes.