Sonographic detection of ingested foreign bodies in the inferior vena cava

Abstract

Ingested foreign bodies usually proceed uneventfully through the intestinal tract; complications rarely occur. The wide variety of clinical presentations they produce often make the diagnosis difficult. We report two cases of sonographic detection of foreign bodies in the inferior vena cava, namely one toothpick and one small (chicken?) bone, which probably caused a duodenocaval fistula. Both patients were initially investigated for recurrent septic episodes, weight loss, and deterioration of general condition.

Duodenocaval fistula as a result of a fish bone perforation

“…2,9 Because symptoms and signs are nonspecific, diagnosis of DCF has been established based on endoscopic, radiologic, surgical, and frequently postmortem findings. 2,4,9 A CT scan appears to be effective in detecting intra-abdominal fish bones. Its accuracy can be up to 100%, being dependent, however, on the slice thickness and the observer awareness, as fish bones can be easily missed or mistaken for another structure.…”

“…An ultrasound scan appears to be sensitive in detecting hyperreflective foreign bodies, but performances are significantly conditioned by obesity, operator skills, and location of the intestinal perforation. 4 Consequently, an ultrasound scan was only described to have been effective in detecting DCF in 2 patients. 4 It results that a thin-section CT scan should be the first test to be performed when DCF is suspected.…”

“…4 Consequently, an ultrasound scan was only described to have been effective in detecting DCF in 2 patients. 4 It results that a thin-section CT scan should be the first test to be performed when DCF is suspected.…”

“…2 Toothpicks and chicken bones have been reported as causative swallowed items of DCF, yet this case is the first to be described consecutively with a fish bone perforation. 1,3,4 Digestive tract perforation from an ingested foreign body is rare. It has been estimated that 80% to 90% will pass uneventfully, and only less than 1% will result in perforation.…”

Aortoiliac endograft-enteric fistula due to an ingested toothpick

“…[13][14][15][16][17][18][19][20][21][22] Five refer to duodenocaval fistulas, 13,14,16,17,21 and another five refer to arterioenteric fistulas. 15,18,19,20,22 The fistula in our patient was found, unexpectedly, between the right limb of the aortoiliac graft and the sigmoid colon.…”