Small bowel perforation secondary to foreign body ingestion mimicking acute appendicitis

Abstract

Rationale: Foreign body ingestion is often encountered in clinical practice; however, intestinal perforation owing to foreign body ingestion is rare. Patient concerns: Here, we present the cases of 2 patients who accidentally swallowed foreign bodies and later presented with pain in the right lower abdominal quadrant. Diagnoses: Both patients were initially diagnosed with acute appendicitis and underwent immediate emergency laparotomy. Interventions: During the operation, the appendix was found to be only mildly inflamed. On transection of the appendix, the mucosa was found to be inflamed, and yellow-white exudate was noted. We, therefore, decided to explore the entire bowel. The bowel examination revealed small bowel perforations, and palpation of the adjacent bowel revealed a hard, sharp object. The object was removed through the perforation site, the perforation was repaired, and the abdomen was closed in layers. Outcome: The postoperative recovery, in both cases, was uneventful. Lessons: Patients who swallow sharp or large foreign bodies should undergo endoscopy as soon as possible to avoid intestinal perforation. Clinicians should inquire about a history of foreign body ingestion. The preoperative diagnosis of intestinal perforation secondary to foreign body ingestion requires a high degree of clinical suspicion and awareness.

Endoscopic Removal of a Denture Lining Material Stuck in the Duodenum

“…Intestinal perforation due to gastrointestinal foreign body occurs predominantly in the terminal ileum and in the sigmoid colon [12]. The small intestine is thought to be at a higher risk of perforation induced by sharp and hard foreign bodies than the remaining gastrointestinal tract because of its narrow lumen and thin wall [13]. With regards to dental materials, Mizuno et al [11] reported that immediate intervention and appropriate selection of devices, such as forceps, snare, and nets, are essential for the removal.…”

Case report on a rare cause of silent duodenal perforation

“…The other potential sites are rectum, colonic flexure, DJ flexure, and the anal sphincters. Rare incidences of foreign body impaction in appendix, colonic, small bowel diverticulum, and in the Meckel’s diverticulum have been reported in literature [ 4 , 5 ]. Foreign body related perforations of the small bowel will usually present with acute symptoms whereas perforations of stomach, duodenum, colon will more likely present with chronic symptoms such as pyrexia of unknown origin, abdominal mass, and abscess collection [ 6 ].…”

Colonic contained perforation of unknown etiology treated conservatively in a 34 year old female patient: a case report

“…Większe ryzyko perforacji wykazują ciał obce o ostrych brzegach i dużych rozmiarach. Nie wszystkie ciała obce można uwidocznić za pomocą badań obrazowych [16]. W pracy Tantan MS et al (2009) opisano dwa przypadki perforacji jelita wywołanej obecnością ciała obcego.…”

“…Badania obrazowe uwidoczniły miejsce perforacji, natomiast nie umożliwiły wykrycia jej przyczyny. W obu przypadkach ustalenie przyczyn perforacji umożliwiły operacje, podczas których stwierdzono obecność ciał obcych [16].…”