A curious case of foreign body induced jejunal obstruction and perforation

Abstract

INTRODUCTIONAccidental and unnoticed ingestion of foreign bodies are not very uncommon. Most of such foreign bodies pass through gastrointestinal tract uneventfully and only on rare instances cause obstruction and/or perforation.PRESENTATION OF CASEWe are reporting a case in which a 45 yr old male presented to accident and emergency department of our institute with complaints of pain abdomen, greenish vomiting, abdominal distension, fever and non passage of flatus and stool following alcoholic binge 15 days back. On presentation tachycardia, hypotension, generalised abdominal tenderness and guarding were present. After initial resuscitation and investigation diagnosis of perforation peritonitis was made and emergency exploratory lapratomy was done and a single perforation with plastic foreign body protruding through it was found in jejunum 5 cm distal to duodeno-jejunal junction.DISCUSSIONThe majority of ingested FBs that reach the stomach pass uneventfully through the gastrointestinal tract. The majority of cases occur in children. Only 1% of patient of patients requires surgical intervention depending upon nature, size and shape of the foreign body.CONCLUSIONPresent case report intends to draw the attention towards possibility of intestinal obstruction and perforation by a single plastic foreign body. High index of suspicion is needed as this foreign body is not even radio-opaque and cannot be picked up in X-ray investigations. Also with increasing use of such plastic materials there are increased chances of such incidents.

A neglected case of chronic abdominal pain due to Lapsi seeds: A unique foreign body at unusual location

“…There are many common objects ingested (e.g. coins, keys, toys, button batteries, pins, marbles, stones, nails and rings) and these typically passes in the stool or patients present with vomiting due to acute abdominal symptoms [ 8 ]. If an object is to impact, then the common locations of the GI tract are the pylorus, duodenum, duodeno-jejunal flexure, Mickel’s diverticulum, ileo-caecal junction and any previous surgical site [ 6 ].…”

Dolor abdominal secundario a fístula ileocecal por ingesta de múltiples cuerpos magnéticos: Caso Clínico

“…Although most of the ingested objects passing through the stomach are expelled without injury 9,10 , 20% are trapped at the anatomical narrowings of the esophagus, pylorus, or ileocecal valve 8 . Only 10-20% of patients who ingest foreign bodies will require endoscopic extraction 11 and about 1% surgical intervention due to complications such as fistulae 12,13 . Among the most common fistula sites we have the rectosigmoid colon and the terminal portion of the ileum.…”

Manejo quirúrgico laparoscópico de perforación de ciego por palillo de madera

“…L a ingesta de cuerpos extraños que alcanzan el estómago pasan de manera inadvertida a través del tracto gastrointestinal, esta situación en ocasiones condiciona la presencia de complicaciones que requerirán una resolución quirúrgica relativamente común. 1 Se han reportado casos de complicaciones en hasta 35% con objetos punzantes ingeridos. Las áreas más comunes de perforación es donde existe angulación (esófago superior e inferior, píloro y válvula ileocecal), con mayor frecuencia en íleon (54%), apéndice y colon (39%).…”

“…Los objetos extraños son los huesos de pescado en 55%, seguido de huesos de pollo, con un predominio de afección por el palillo de madera en duodeno, alcanzando una mortalidad de 18%. [1][2][3] Manejo quirúrgico laparoscópico de perforación de ciego por palillo de madera…”