Spiral CT and multidetector-row CT diagnosis of perforation of the small intestine caused by ingested foreign bodies

Abstract

The aim of this retrospective study was to emphasize the performances of spiral CT (HCT) and multidetector-row CT (MDCT) as very effective imaging modalities for the diagnosis of intestinal perforations caused by calcified alimentary foreign bodies. Eight sites of perforations of the ileum by ingested foreign bodies were found in seven patients--one patient presenting with two separate sites of perforation. The diagnosis was successfully made by HCT in four patients and MDCT in the remaining three. Involuntarily and generally unconsciously ingested chicken and fish bones were the implicated calcified foreign bodies. The acute clinical presentations were nonspecific, mimicking more common acute abdominal conditions. A thickened intestinal segment (7/8 sites) with localized pneumoperitoneum (4/8 sites), surrounded by fatty infiltration (4/8 sites) and associated with already present or developing obstruction or sub-obstruction (5/7 patients) were the most common CT signs, but the definite diagnosis was clearly made by the identification of the calcified foreign bodies (7/7 patients). In each patient, this identification was only possible thanks to the scrupulous analysis of very thin overlapping reconstructions obtained not only in the perforation sites (6/8 sites), but also through the entire abdomen (2/8 sites). Our report emphasizes the high performances of CTA and MDCT in identifying intestinal perforation caused by calcified alimentary foreign bodies. Moreover, the high specificity of the CT diagnosis made it possible to avoid surgerical exploration in three patients.

Small Bowel Perforation Due to a Fishbone: A Case Report

“…Thus, it is the first method of choice for evaluating patients with acute abdominal pain and for detecting foreign bodies. 3 US revealed minimal free fluid in the pelvic region of our case. Following this, abdominal CT with contrast agent revealed a typical image of the perforation caused by ingested fish bone.…”

“…12 Coulier et al also reported that perforation is most commonly observed at the angular regions like the distal portion of the ileum where lumen is narrow. 3 With our case, the perforation was at 15 cm proximal of the ileocecal valve. The perforation may seldom occur at regions like the hernia sac, Meckel diverticulum, and appendix.…”

“…Although, different signs have also been reported in the literature including localized abdominal abscess, colorectal, colovesical and enterovesical fistula, inflammatory mass or omental pseudotumor, chronic or acute intestinal obstruction, bleeding, endocarditis, renal, and ureteral colic. 3,5,13 On occasion, they may can remain asymptomatic.…”

Absceso de pared dudenal secundario a "palillo de dientes" enclavado en duodeno como causa inusual de dolor abdominal crónico

“…La tomografía confiere una mayor utilidad en casos específicos dado que puede descartar complicaciones como las perforaciones y abscesos. Adicionalmente, puede brindar mejor información sobre la localización del CE (intra o extraluminal) con el fin de determinar la conducta y, en caso de requerirlo, la vía de abordaje (20,21).…”

Small Bowel Perforation Due to Fish Bone: A Case Report

“…3 Even with a detailed clinical presentation, diagnosis may be difficult and delayed since the ingestion fish bones or other foreign bodies may not be mentioned in the history of the patient.…”