Duodenal obstruction secondary to date stone impaction

Intestinal Perforation by Ingested Foreign Bodies

The aim of our article is to study the incidence, diagnosis, and treatment of bowel perforation by foreign body ingestion. Bowel perforation by foreign body ingestion has been believed to be relatively rare, and most commonly caused by fish bones, chicken bones, and toothpicks. Our clinical experience, however, suggests such perforations may be more common than previously thought, and caused by various other objects as well. Medical records of all patients diagnosed with foreign body–induced intestinal perforation, from the Department of General Surgery at Tonji Hospital, from January 2000 to June 2015, were retrospectively analyzed. A total of 17 men and 8 women suffered intestinal perforations by ingestion of dietary foreign bodies. Among the 25 total patients, 4 ingested foreign bodies intentionally, whereas the other 21 cases were accidental. The foreign bodies were identified by plain X-ray film in 2 patients (2 cases of needles) and by multidetector computed tomography (MDCT) in 11 patients (6 cases of date stones, 3 cases of metallic objects, and 2 cases of bone fragments), thus supporting the correct preoperative diagnosis (13 cases; 52%). The most common location of the perforation was the terminal ileum (n = 17). The offending objects were date stones (n = 13), bones (n = 7), and metallic objects (n = 5). The most common treatment was removal of the foreign body and closure of the perforation with simple suture (n = 22). Ten patients were treated laparoscopically. The present study shows that the most common foreign bodies causing intestinal perforation are date stones and bones. Although about 50% of the foreign bodies could be identified by MDCT, definite diagnosis remained preoperatively difficult. Consequently, because of high misdiagnosis rates, laparoscopy may be the optimal choice for diagnosis and treatment of bowel perforation by foreign bodies.

An unusual cause of gastric outlet obstruction during percutaneous endogastric feeding: a case report

Introduction

The differential diagnoses of acute abdomen in children include common and rare pathologies. Within this list, different types of bezoars causing gastrointestinal obstruction have been reported in the literature and different methods of management have been described. The aim of this article is to highlight a rare presentation of lactobezoars following prolonged percutaneous endoscopic gastrostomy feeding and its successful surgical management.

Case presentation

A 16-year-old boy was admitted to a paediatric ward with abdominal distension and high output from his permanent gastrostomy feeding tube, with drainage of bilious fluids. The clinical, radiological and endoscopical examinations were suggestive of partial duodenal obstruction with multiple bezoars in the stomach and duodenum. Gastrojejunostomy was performed after the removal of 14 bezoars. The child had an uneventful postoperative course and was discharged on the sixth postoperative day in a stable condition.

Conclusion

Lactobezoars should be included in the differential diagnosis of acute abdominal pain in patients with percutaneous endogastric feeding. Endoscopy is important in making the diagnosis of this surgical condition of the upper gastrointestinal tract in a child.