Small bowel obstruction caused by snail's shell: radiographic and CT findings

Repeated Small Bowel Obstruction Caused by Chestnut Ingestion without the Formation of Phytobezoars

A small number of cases of small bowel obstruction caused by foods without the formation of phytobezoars have been reported. Repeated small bowel obstruction due to the ingestion of the same food is extremely rare. We present the case of 63-year-old woman who developed small bowel obstruction twice due to the ingestion of chestnuts without the formation of phytobezoars. This is the first reported case of repeated small bowel obstruction caused by chestnut ingestion. Careful interviews are necessary to determine the meal history of elderly patients and psychiatric patients.

Retention of foreign body in the gut can be a sign of congenital obstructive anomaly: a case report

Introduction

Small smooth objects that enter the gut nearly always pass uneventfully through the gastrointestinal tract. Retention of foreign objects may occur due to congenital obstructive anomaly of the gut.

Case presentation

We report here a child who presented with features of small gut obstruction which were attributed to a foreign body impacted in the intestine. At surgery, an annular pancreas was detected and the foreign body was found to be lodged in the distended proximal duodenum.

Conclusion

The reported case highlights the fact that an impacted radio-opaque foreign body in a child should warn the pediatrician to the possibility of an obstructive congenital anomaly.

An apricot story: view through a keyhole

BACKGROUND

Very few cases of small bowel obstruction due to ingested fruits have been described in literature, and most of these have managed by a laparotomy. Laparoscopic assisted surgery can effectively deal with such impacted foreign bodies, thereby avoiding a formal laparotomy.

CASE PRESENTATION

A 75 years old lady was admitted via the Accident and Emergency to the surgical ward with a three-day history of abdominal pain and vomiting. Investigations were suggestive of acute small bowel obstruction. On laparoscopy, there was an area of sudden change in calibre of small bowel with dilated proximal and collapsed distal segment in distal jejunum. A foreign body, dried undigested apricot, was extracted by mini-laparotomy.

DISCUSSION

Small bowel obstruction is a frequent cause of emergency surgery, and aetiology may include food bolus obstruction. Diagnosis is usually confirmed intra-operatively. Foreign body impacted in small bowel can be removed by open or laparoscopic methods.

CONCLUSION

Generally, laparotomy is performed for diagnosis and management in acute bowel obstruction, but with increasing expertise, laparoscopy can be equally effective with all the other advantages of minimal access approach.

Foreign body ingestion of blister pill pack causing small bowel obstruction

We report a case of foreign body ingestion of a blister pill pack, causing small bowel obstruction. A 76-year-old woman on multiple medications presented with 3 days of progressive abdominal distention, nausea, and vomiting. A computed tomography (CT) scan demonstrated small bowel obstruction with a distinctive metallic foreign body in the distal ileum with associated wall thickening and mesenteric inflammatory changes. At exploratory laparotomy, an impacted, intact blister pill pack was removed from the distal ileum. The ingestion of blister pill packs has been associated with a range of clinical and imaging findings. To our knowledge, this is the only reported case of CT diagnosis of small bowel obstruction caused by blister pack ingestion. Early recognition of the imaging findings of an ingested blister pill pack is important to expedite appropriate management.

Small bowel obstruction due to inflammation secondary to ingested bone

We report the CT appearances of an ingested pork bone in the lumen of small bowel in a 66-year-old man with an intact and virgin gastrointestinal tract. CT scan demonstrated the site of obstruction at distal jejunum with associated irregular narrowing and proximal small bowel dilatation as well as the bone lodged in the non-dilated terminal ileum. Laparotomy and histology of the resected small bowel confirmed the CT appearances that the obstruction was caused by adhesions and extensive inflammation across the bowel wall in the distal jejunum from trauma as the bone traversed down the lumen. We believe that this is the first reported preoperative CT scan finding of a case of small bowel obstruction due to adhesions and inflammation secondary to ingested bone.

A penny for your thoughts: Small bowel obstruction secondary to coin ingestion

We report a case of small bowel obstruction secondary to coin ingestion. A 22-year-old woman presented to the Emergency Department (ED) with a 3-week history of abdominal pain. Upon initial history the patient denied any foreign body ingestion. Only after computed tomography (CT) scanning of the abdomen and pelvis did the patient admit to deliberate ingestion of a single United States penny coin. During surgical evaluation it was found that the coin had lodged near the ileocecal valve and an inflammatory mass had formed around the intraluminal coin, causing a 10 x 7 cm fibrous tumor to completely obstruct the small bowel. It is thought that oxidation of the coin, with subsequent exposure of its high zinc content, instigated the inflammatory cascade.