Ingested metallic foreign body impacted in the vermiform appendix presenting as acute appendicitis: Case report

Unexpected Culprit: Unveiling a Unique Case of Appendicitis Triggered by a Foreign Object

Appendicitis is a common surgical emergency marked by inflammation of the appendix, often due to blockage of the appendix lumen by fecoliths, lymphoid hyperplasia, or neoplasms. While various causes are known, appendicitis triggered by a foreign body (FB) is exceptionally rare. This case report highlights a rare presentation of appendicitis in a 32-year-old male with no significant medical history, who presented with acute lower right abdominal pain, fever, and vomiting. Initial evaluation suggested appendicitis, further supported by laboratory findings and diagnostic imaging revealing a retrocecal appendix with surrounding inflammation. Remarkably, an FB, a fish bone, was discovered lodged within the perforated appendix, elucidating the unusual etiology. Emergency laparotomy confirmed the diagnosis and facilitated prompt surgical intervention. This case underscores the importance of thorough evaluation and consideration of uncommon causes in patients presenting with acute abdominal pain, illustrating the critical role of detailed history-taking and clinical acumen in guiding management decisions and ensuring favorable patient outcomes.

Foreign Body Appendicitis Coexisting With Ascariasis in a Pediatric Patient: A Case Report

In clinical practice, the typical approach to ingested foreign bodies in stable patients involves expectant management, as most materials pass through the gastrointestinal (GI) tract without adverse effects. However, foreign bodies that travel through the appendix's lumen can cause acute appendicitis due to their inability to exit the colon. Rarer causes of appendicitis include parasitic infiltration by Ascaris lumbricoides. The wandering behavior of Ascaris lumbricoides within the GI tract can lead to various surgical complications in the abdomen. Occasionally, these parasites can migrate to the vermiform appendix, where they may either induce pathological changes or remain asymptomatic. We report an unusual case of an eight-year-old Pakistani female patient who presented to the emergency room with pain in the right iliac fossa, associated with anorexia and nausea, for one day. On examination, the patient was found to be vitally stable, with right iliac fossa tenderness noted on palpation. Additionally, the patient exhibited positive pointing, rebound, Rovsing, and psoas signs. Her medical history revealed that she had ingested a metallic needle seven months ago. Blood tests were undertaken, and an abdominal X-ray confirmed the existence of a radiopaque metallic object in the right lower quadrant of the abdomen. The patient underwent an open appendicectomy for acute appendicitis and was discovered to have a metallic needle lodged in the vermiform appendix. Concurrently, she also had ascariasis, as she vomited a 23-cm-long Ascaris lumbricoides worm. It is important to consider both mechanical and parasitic etiologies in diagnosing acute appendicitis; detailed evaluation and management strategies are necessary to address these unique etiologies effectively.

Foreign Body Ingestion by a Psychiatric Patient Requiring an Appendectomy: A Case Report

In the surgical field, the correct approach to the psychiatric patient represents a medical challenge, given the special considerations to be taken in the individualization of their diagnosis and treatment. We present an uncommon case of a 29-year-old patient with associated psychiatric pathology who presented to the emergency room after the introduction of two foreign bodies into the nasal cavity. After the endoscopic removal of one of the foreign bodies, the X-ray follow-up shows a second foreign body into the esophagus, which progressed to the vermiform appendix, causing the classical clinical signs of acute appendicitis as a complication. The importance of considering that events treated by the otorhinolaryngology area may have complications for urgent management by the general surgery service is denoted in this article.

Appendiceal Foreign Bodies in Adults: A Systematic Review of Case Reports

Adults can accidentally swallow foreign bodies (FBs) with food. In rare occasions, these can lodge in the appendix lumen causing inflammation. This is known as foreign body appendicitis. We conducted this study to review different types and management of appendiceal FBs. A comprehensive search on PubMed, MEDLINE, Embase, Cochrane Library and Google Scholar was performed to detect appropriate case reports for this review. Case reports eligible for this review included patients above 18 years of age with all types of FB ingestion causing appendicitis. A total of 64 case reports were deemed to be eligible for inclusion in this systematic review. The patient mean age was 44.3 ± 16.7 years (range, 18-77). Twenty-four foreign bodies were identified in the adult appendix. They were mainly lead shot pellet, fishbone, dental crown or filling, toothpick, and others. Forty-two percent of the included patients presented with classic appendicitis pain, while 17% were asymptomatic. Moreover, the appendix was perforated in 11 patients. Regarding modalities used for diagnosis, computed tomography (CT) scans confirmed the presence of FBs in 59% of cases while X-ray only managed to detect 30%. Almost all of the cases (91%) were treated surgically with appendicectomy and only six were managed conservatively. Overall, lead shot pellets were the most common foreign body found. Fishbone and toothpick accounted for most of the perforated appendix cases. This study concludes that prophylactic appendicectomy is recommended for the management of foreign bodies detected in the appendix, even if the patient is asymptomatic.

Foreign body ingestion: Is intervention always a necessity?

Introduction

Intentional and accidental foreign body ingestion are commonly encountered in clinical practice. In adults, intentional foreign body ingestion is frequently observed among individuals with psychiatric disorders and prisoners. Controversies exist regarding the management of sharp or pointed objects. We contribute to this existing controversy by presenting a case of a 43-year-old male who accidently ingested a metallic screw and was managed successfully through endoscopic retrieval.

Case presentation

We discuss a case of a 43-year-old male presented to our emergency department after accidently swallowing a metallic screw, 1 h and a half prior to his presentation. He was initially asymptomatic then started to complain of vague abdominal symptoms. X-rays of the chest and abdomen demonstrated the presence of a metallic screw at the mid-abdomen. Computed tomography scan of the abdomen then confirmed its presence within the gastric lumen, with no evidence of gastric or bowel perforation. The patient was managed via esophagogastroduodenoscopy in which the ingested screw was extracted. He was discharged after 24 hours in a good condition.

Clinical discussion

A limited number of epidemiological studies have shed light on the prevalence and incidence of foreign body ingestion among adult individuals. Probability of spontaneous passage depends on several factors including the size, shape and composition of the impacted item, as well as the age of patient and duration of ingestion prior to presentation.

Conclusion

Considering the variation of ingested objects and the availability of several therapeutic approaches, a patient-tailored management plan should always be established.

Acute complicated appendicitis caused by an ingested toothpick – A case report

Introduction and importance

Acute appendicitis is one of the most common presentations to the emergency department, particularly in young adults. A combination of clinical suspicion, inflammatory blood markers and imaging modalities such as ultrasound and CT are used for its definitive diagnosis. Early detection and intervention are paramount to reduce morbidity and mortality. Laparoscopic appendicectomy is the current gold standard in the management of appendicitis, especially if complicated according to EAES guidelines. There are few documented cases in the literature of acute appendicitis secondary to foreign body ingestion. On account of this, there are currently no guidelines for its management. Our literature review highlights the importance of surgical management of foreign body acute appendicitis.

Case presentation

This case report describes the rare presentation of acute complicated appendicitis caused by an ingested toothpick in a 64 year old woman. The patient was admitted with a 3 day history of lower abdominal pain, localizing to the right iliac fossa with raised inflammatory markers. CT imaging reported acute complicated appendicitis. Laparoscopic appendicectomy was performed during which a toothpick was seen protruding through the appendiceal wall. Post operatively the patient was treated with IV antibiotics for 5 days prior to discharge.

Clinical discussion

Due to the rare nature of foreign body appendicitis there are no specific guidelines on the respective surgical approach. A literature review showed that in the setting of foreign body appendicitis, surgical intervention is paramount with no scope for conservative management.

Conclusion

Surgical approach is based on the clinical judgement and skillset of the operating surgeon.

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Remember foreign body ingestion as a cause of appendicitis

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Management of foreign body appendicitis is surgical intervention.

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Open vs laparoscopic approach depends on the surgeons clinical judgement, preference and skillset.

Magnet Beads Impacted in the Appendix of a Child: A Case Report and Review of the Literature

Foreign body ingestion is a commonly encountered problem in the pediatric population, which can be a source of severe distress to parents and caregivers. Certain foreign bodies such as magnets, bones, and button batteries can be particularly dangerous and lead to some serious complications like gastrointestinal obstruction, perforation, or bleeding depending on the nature of the foreign body, the location of impaction, and the period since ingestion. In this report, we discuss a case of a 23-month-old girl who ingested multiple magnets that got trapped within the appendix resulting in continuous vomiting.

Ingestion of huge number of metallic nails impacted in the stomach and cecum in a mentally abnormal woman: Case report

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Foreign bodies may be ingested unconsciously, intentionally or in patients who have psychological abnormalities.

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The majority of foreign bodies are passed smoothly with no problems.

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Ingestion of sharp and long foreign bodies usually requires surgical intervention.

Background

Foreign bodies may be ingested unconsciously, intentionally or in patients who have psychological abnormalities. The majority of foreign bodies are passed smoothly with no problems if they passed the esophagus, however some may be lodged in areas of anatomical narrowing which may require endoscopic or surgical intervention.

Case presentation

A 37-year -old mentally abnormal woman presented to the emergency department complaining from abdominal pain for 2 days. The family reported a history of ingestion of multiple metallic nails one week before presentation. Abdominal examination showed generalized tenderness and guarding. Plain abdominal X-ray showed multiple metallic nails in the upper abdomen and the right lower abdomen. Laparotomy was performed, one of the nails was causing perforation of the gastric wall, huge number of metallic nails were extracted from the stomach and cecum, appendectomy was performed.

Conclusion

Ingestion of sharp and long foreign bodies usually requires surgical intervention, after surgery close observation and psychological consultation is required to prevent repeated ingestions.

Intussusception of the vermiform appendix caused by mucinous tumor of the appendix: Case report

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Acute appendicitis is the commonest surgical emergency worldwide.

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Surgery is usually needed which could be done by open or laparoscopic techniques.

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Tumors of the appendix may cause intussusception of the appendix.

Introduction

Intussusception of the appendix occurs when part of the appendix passes the part next to it or the whole appendix to the cecum. It is classified as primary or secondary, or can be classified to partial or complete. Most cases are secondary and partial. Patients usually presents with right lower abdominal pain and most cases are diagnosed during surgery.

Case presentation

A 27-year-old female presented with right iliac fossa pain and nausea for 2 days. Abdominal examination showed tenderness, guarding, and rebound tenderness at the right iliac fossa. The WBC count was 11,000 c/mm and the urinalysis was normal.

At surgery, there was intussusception of the vermiform appendix in its middle part with palpable mass attached to its wall. Appendicectomy was performed successfully. The result of the histopathology was consistent with mucinous cystadenoma of the appendix with no evidence of malignancy.

Conclusion

Surgery is the main form of treatment as most of the cases are diagnosed during surgery, the operation type may include appendicectomy or more extensive surgery is required such as right hemicolectomy depending on the cause. Surgery can be performed laparoscopically. Trials of colonoscopic reduction are not recommended.