Intestinal Perforation by Foreign Body: Case Report and Literature Review
Author(s)
Download Full PDF Pages: 58-65 | Views: 1284 | Downloads: 306 | DOI: 10.5281/zenodo.3445910
Abstract
The ingestion of foreign bodies intentionally or accidentally is found worldwide especially in paediatric age group (8), elderly, mentally subnormal individuals, alcoholic and drug abusers proving to be a major cause of morbidity and mortality (7). The ingestion of foreign bodies is rarely associated with intestinal perforation, even if a sharp object is swallowed. About 80-90% of ingested foreign bodies are passed spontaneously (5). The consequences may range from un-noticed passage per rectum to severe peritonitis following bowel perforation although less than 1% causes perforation (6) and there may be acute bowel obstruction.
Method:
This is a 21 year old male patient who presented with abdominal pain. This patient states that the abdominal pain started after the ingestion of liquid. On physical examination the abdomen was firm, flat, no surgical scars, with generalized tenderness and guarding principally in the epigastric to suprapubic region. The investigations which were done had essentially contributed no additional information suggestive of the definitive pathology.
Result:
This patient was resuscitated with intravenous fluid therapy, analgesia, prophylactic antibiotic along with deep vein thrombosis prophylaxis and booked for exploratory laparotomy. The findings at laparotomy are that of a perforated proximal loop of jejunum with a piece of chicken bone.
Conclusion:
The vague symptoms that can be found on physical examination as well as the lack of patients ability to recall whether or not they had ingested a foreign body is the main difficulty in the diagnosis of this entity.
Keywords
intestinal perforation, foreign body, chicken bone
References
i. Mesina C, et al Problems of Diagnosis and Treatment Caused by Ingested Foreign Bodies. Chirurgia (2013) 108: 400-406
ii. Ayantunde AA, Oke T.A review of gastrointestinal foreign goodies. Int Clinical Pract. 2006:60(6):735–9.
iii. Goh BK, Chow PK, Quah HM, Ong HS, Eu KW, Ooi LL, Wong WK.Perforation of gastro-intestinal tract secondary to ingestion of foreign bodies. World J Surg. 2006;30(3):372–7.
iv. Karamarkovic AR, Djuranovic SP, Popovic NP, Bumbasirevic VD, Sijaki AD, Ivan V.Hepatic abscess secondary to a rosemary twig migrating from stomach into liver. World j Gastroenterol. 2007;13(4):5530–32.
v. Perelman H. Toothpick perforation of the gastrointestinal tract. J Abdom Surg 1962; 4: 51-53
vi. McPherson RC, Karlan M, Williams RD. Foreign body perforation of the intestinal tract. Am J Surg 1957; 94: 564-566
vii. Singla DK, Sonkar MD, Thami G, Agrawal N. An unusual case of small bowel perforation due to ingestion of foreign body. Int. J. Pharm. Med. Res., 2014;2(1):5-7.
viii. Litovitz T., Schmitz BF., Ingestion of cylindrical and button batteries: an analysis of 2382 cases, Pediatrics 1992; 89 (4 Pt2):747-57.
ix. Steenvoorde P., Moues CM., Viersma JH., Gastric perforation due to the ingestion of a hollow toothpick: report of a case, Surg Today 2002;32:731-3.
x. Hsu SD., Chan DC., Liu YC., Small-bowel perforation caused by fish bone, World J Gastroenterol 2005;11:1884-5.
xi. Nagaraj HS., Sunil I., Multiple foreign body ingestion and ileal perforation, Pediatr Surg Int 2005;21:718-20.
xii. Bhatia R., Deane AJ., Landham P., Schulte KM., An unusual case of bowel perforation due to fish fin ingestion, Int J Clin Pract 2006;60:229-31.
xiii. Rodríguez-Hermosa JI., Codina-Cazador A., Sirvent JM., Martín A et al., Surgically treated perforations of the gastrointestinal tract caused by ingested foreign bodies, Colorectal Disease 2012;10(7):701-707.
xiv. Velitchkov NG., Grigorov GI., Losanoff JE., Kjossev KT., Ingested Foreign Bodies of the Gastrointestinal Tract: Retrospective Analysis of 542 Cases, World J Surg 2005; 20:1001-1996.
xv. Cash DJ., Sadat MM., Abu-Own AS., Anorectal abscess and fistula caused by an ingested chicken bone, Am J Gastroenterol 2004; 99:1617-8
xvi. Pinero Madrona A., Fernández Hernández JA., Carrasco Prats et al., Intestinal perforation by foreign bodies, Eur J Surg 2000;166:307-9.
xvii. Yao CC., Yang CC., Liew SC., Lin CS., Small bowel perforation caused by a sharp bone: laparoscopic diagnosis and treatment, Surg Laparosc Endosc Percutan Tech., 1999; 9(3):226-7.
xviii. Nylund K., Odegaard S., Hausken T., et al., Sonography of the small intestine, World JGastroenterol 2009; 15:1319–1330.
xix. Chau WK., Wu SSM., Wang JY., Ultrasonic detection of an intraabdominal Foreignbody, J Clin Ultrasound 1985; 13:130–131.
xx. Matricardi L., Lovati R., Intestinal perforation by a foreign body: diagnostic Usefulness of ultrasonography, J Clin Ultrasound 1992; 20:194–196.
xxi. Rioux M., Langis P., Sonographic detection of clinically unsuspected swallowed toothpicks and their gastrointestinal complications, J Clin Ultrasound 1994; 22:483–490.
xxii. Coulier B., Tancredi MH., Ramboux A., Spiral CT and multidetector-row CT diagnosis of perforation of the small intestine caused by ingested foreign bodies, Eur Radiol 2004; 14:1918–1925.
xxiii. Gonzalez JG., Gonzalez RR., Patino JV., Garcia AT., Alvarez CP., Pedrosa GSA., CT findings in gastrointestinal perforation by ingested fish bones, J Comput Assist Tomogr 1988;12:88–90.
xxiv. Winchmann MW, Huttl TP, Billing Ajauch KW: laparoscopic management of small bowel perforation caused by a toothpick, Surgical Endoscor, 2004: 18:718.
xxv. Pavlidis TE, Marakis GN, Triantafyllou A, Psarras K, Kontoulis TM, Sakantamis AK. Management of ingested foreign bodies. How justifiable is a waiting policy? Surg Laparosc Endosc Percutan Tech. 2008;18(3):286-7.
xxvi. Eisen GM, Baron TH, Dominitz JA, Feigel DO, Goldstein JL, Johansonn JF et al. Guideline for the management of ingested foreign bodies. Gastrointest Endosc. 2002;55(7):802-6.
xxvii. Jackson CL. Foreign bodies in the esophagus. Am J Surg. 1957;93(2):308-12.
xxviii. Baraka A, Bikhazi G. Oesophageal foreign bodies. Br Med J. 1975;1(5957):561-3.
xxix. Nandi P, Ong GB. Foreign body in the oesophagus: review of 2394 cases. Br J Surg. 1978;65(1):5-9.
xxx. Clerf LH. Foreign bodies in the air and food passages: observations on end-results in a series of nine hundred and fifty cases. Surg Gynecol Obstet. 1940;70:328-39.
xxxi. Barros JL, Caballero A Jr, Rueda JC, Monturiol JM. Foreign body ingestion: management of 167 cases. World J Surg. 1991; 15(6):783-8.
xxxii. Blaho KE, Merigian KS, Winbery SL, Park LJ, Cockrell M. Foreign body ingestion in the Emergency Department: case reports and review of treatment. J Emerg Med. 1998;16(1):21-6.
xxxiii. Murshid KR, Khairy GE. Laparoscopic removal of a foreign body from the intestine. J R Coll Surg Edinb. 1998;43(2):109-11.
xxxiv. Akhtar S, McElvanna N, Gardiner KR, Irwin ST. Bowel perforation caused by swallowed chicken bones -a case series. Ulster Med J. 2007;76(1):37-38.
xxxv. Moreira CA, Wongpakdee S, Gennaro AR. A foreign body (chicken bone) in the rectum causing extensive perirectal and scrotal abscess: report of a case. Dis Colon Rectum. 1975;18(5):407-9.
xxxvi. Singh RP, Gardner JA. Perforation of the sigmoid colon by swallowed chicken bone: case reports and review of literature. Int Surg. 1981;66(2):181-3.
xxxvii. Yeung KW, Chang MS, Hsiao CP, Huang JF. CT evaluation of gastrointestinal tract perforation. Clin Imaging. 2004;28(5):32933.
xxxviii. Brady PG. Endoscopic removal of foreign bodies. Therapeutic Gastrointestinal Endoscopy. 1985;85:67-93.
Cite this Article: