Foreign objects encountered in the abdominal cavity at CT

Imaging of a Rare Foreign Body Within the Female Pelvis Following Recent Laparoscopic Hysterectomy: A Case Report

Foreign bodies are commonly encountered in the female pelvis and may be placed intentionally or unintentionally due to underlying pathological conditions. It is imperative for radiologists to accurately identify these foreign objects to guide appropriate clinical care. In this case, a retained condom was misinterpreted as an abscess in a 45-year-old patient following a total hysterectomy complicated by vaginal cuff dehiscence and a previous repair at an outside hospital. This case highlights the importance of obtaining a detailed clinical history in the identification of foreign bodies, assessing potential complications, and guiding further management.

Foreign body-intestinal canal angle guides management of ingested foreign bodies in the lower gastrointestinal tract

BACKGROUND

Determining whether prompt surgery is required for patient with ingested foreign bodies is clinically important.

PURPOSE

To evaluate the potential value of computed tomography (CT) in guiding the selection of surgical treatment for patients with ingested foreign bodies in the lower gastrointestinal tract.

METHODS

Between January 2014 and December 2023, we analyzed the data of 58 patients (median age: 65.4 years; range, 31-96 years) with ingested foreign bodies in the lower gastrointestinal tract who underwent CT examinations. Patients were treated either conservatively (35 cases) or surgically (23 cases). The angle between the long axis of the foreign body and the intestinal canal (FB-IC angle) was measured. CT findings and clinical variables were evaluated to identify potential indicators for surgical treatment through univariate and multivariate logistic regression analyses.

RESULTS

Univariate analysis revealed the FB-IC angle (P = 0.002), presence of free peritoneal gas (P = 0.002), white blood cell count (P = 0.018), and neutrophil count (P = 0.007) as significant factors associated with surgical treatment. Multivariate analysis demonstrated that the FB-IC angle (odds ratio, 1.033; P = 0.045) and the presence of free peritoneal gas (odds ratio, 41.335; P = 0.002) are independent indicators for surgical management. The FB-IC angle showed an area under the receiver operating characteristic curve of 0.755, with a cutoff value of 51.25 degrees.

CONCLUSION

The FB-IC angle and presence of free peritoneal gas serve as potential predictive imaging markers for surgical intervention.

Juxta-Vesical Urinary Stones: An Extremely Rare Finding Secondary to Bladder Rupture and Squamous Cell Carcinoma in a Patient on Clean Intermittent Self-Catheterization

We present a rare case of juxta-vesical urinary stones in the lesser pelvis, incidentally diagnosed during the investigation of a urinary tract infection (UTI). The patient (male) had a history of neurogenic bladder and performed self-catheterizations. After the initial workup, the patient was admitted with a complicated UTI diagnosis. CT scan of the abdomen and pelvis depicted multiple bladder stones, some calculi lying juxta- and retro-vesically, an abscess cavity, and diffuse thickening of the bladder. The abscess was adherent to the bladder wall, containing calculi, too. We presumed that the patient self-inflicted a bladder rupture when performing clean intermittent self-catheterization (CISC) and stones dislodged in the pelvis due to his poor bladder sensation. Flexible cystoscopy was attempted but was not completed due to stone obstruction and poor bladder compliance. The patient underwent open surgical exploration. Several calculi were removed, the abscess was drained, and bladder wall biopsies were taken. Pathology results revealed invasive squamous bladder carcinoma; the patient was listed for radical cystectomy. We aim to familiarize the clinician with rare complications that should be taken into consideration when treating patients on CISC and present an extremely rare clinical finding of juxta-vesical lithiasis.

Ingested Potassium Chloride Pills on Imaging Misdiagnosed As Foreign Bodies in the Stomach: An Insight on Radiopaque/Hyperdense Substances in the Gastrointestinal Tract

Foreign bodies are very common in the GI tract. Around 100,000 cases are reported each year in the United States. A total of 80% of those foreign body ingestions occur in the pediatric population. There are several reasons for foreign body impaction in the GI tract in adults. Psychiatric problems, anatomical abnormalities in the GI tract such as esophageal web, diverticula, stricture, and eating big food boluses are frequent causes of foreign body impaction in adults. Rarely do radio-opaque ingested materials appear as a foreign body in imaging studies. Such objects include several commonly used medications such as iron preparations, potassium chloride pills, amiodarone, spironolactone, bisoprolol, and lisinopril. Herein, we present one such case of potassium chloride pill ingestion, where it appeared as a foreign body in the stomach. However, on the endoscopic examination and repeat X-ray, the foreign body had been digested and disappeared.

CT Evaluation of Swallowed Foreign Bodies Located in the Gastrointestinal System

Background and objective

CT imaging is important in detecting the location and the structure of swallowed foreign bodies and assessing their complications, due to its features such as the ability to show the detailed anatomical structure and enable multiplanar examination. In this study, we aimed to analyze the CT findings of swallowed foreign bodies located in the gastrointestinal tract and compare them with the data in the existing literature.

Materials and methods

We conducted a retrospective archive study to achieve our goals. Patients who presented to our radiology department with the preliminary diagnosis of foreign body ingestion, abdominal pain, or acute abdomen and were found to have a foreign body in the gastrointestinal tract on CT between April 2018 and April 2021, especially those in whom the presence of a foreign body was confirmed by endoscopy or surgery, were included in our study. The patients were evaluated in terms of age, gender, foreign body type, foreign body localization, and complications.

Results

A total of 31 patients (15 males and 16 females) were included in the study. The patients’ age ranged from 1 to 67 years, and the mean age was 28.5 ±5.4 years. The most common foreign bodies found were metallic toy parts (n=11, 35%), and most of the foreign bodies were located in the ileum (n=9, 29%) of the patients. Complications were observed in nine patients (29%). In patients with complications, the most common finding was perforation (n=3, 38%).

Conclusion

When a CT exam is performed on patients with abdominal pain, the gastrointestinal tract should be carefully evaluated to determine if a foreign body is involved and to analyze the complications caused by the foreign body.

Fat-containing pelvic lesions in females

Pelvic tumors are common in females and have a broad differential diagnosis. The clinical management of pelvic tumors varies widely-from observation to surgical resection-and imaging plays a pivotal role in diagnosis and clinical decision-making in these cases. In particular, imaging can help determine the organ of origin and tissue content of these tumors, which are the most important steps to narrowing the differential diagnosis. Fat has a characteristic appearance and is often easily identified on ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI). The amount and distribution of intralesional fat varies in different types of tumors. Macroscopic intralesional fat is often easily recognized by its hyperechoic appearance on US and low attenuation on CT similar to subcutaneous fat. On MRI, macroscopic fat is hyperintense on T1-weighted (T1W) images, with characteristic signal loss on fat-saturated sequences and India-ink artifact on opposed-phase T1W images. Macroscopic fat is the hallmark of teratomas, which are the most common ovarian neoplasms. Uterine lipoleiomyomas, peritoneal loose bodies, intraperitoneal and extraperitoneal primary lipomatous tumors such as lipoma and liposarcomas, and extra-adrenal myelolipomas are other pelvic masses distinguished by the presence of macroscopic fat. However, the imaging diagnosis of pelvic masses containing minimal or microscopic fat, such as immature ovarian teratomas, steroid cell ovarian neoplasms, and extramedullary hematopoiesis, can present a diagnostic challenge owing to their nonspecific appearance on US or CT. Obtaining MRI with in-phase and opposed-phase dual-echo T1W sequences and depicting chemical shift artifacts can be helpful in distinguishing these lesions.

Dissolving Potassium Tablets Masquerading as Concealed Foreign Body Ingestion

Foreign body ingestion is a common consultation for gastroenterologists. Without knowing the object(s) ingested, the differential diagnosis is broad, especially in patients with underlying mental health conditions, such as uncontrolled bipolar disorder, prior suicide attempts, or recreational drug use. The differential should include substances taken with suicidal intent or for concealment of illicit drugs. Certain foreign objects may require urgent or emergent endoscopic intervention. However, one should also consider benign, iatrogenic causes such as large, radiolucent potassium pills given in the emergency department, which do not require further intervention or hospitalization.

Role of computed tomography (CT) in identifying foreign body ingestion in an individual with autism - A case report

Foreign body ingestions are quite common and most often will uneventfully pass in stool, however, some ingestions, can lead to complications such as obstruction. If left untreated, this can lead to perforation and fistula formation. Hence, threshold for intervention should be low and diagnostic imaging can assist with treatment decisions. We present to you a case of 17-year-old male with non-verbal autism with an unusual hollow foreign body ingestion leading to small bowel obstruction.

Diagnostic approach to small-bowel wall thickening: Beyond Crohn's disease and cancer

Although small-bowel wall thickening is a common manifestation of Crohn's disease and tumors, many other entities can give rise to similar imaging findings. The small bowel is difficult to access by endoscopy, so radiologic imaging tests play an essential role in the diagnosis of conditions involving the small bowel. The main objectives of this paper are to explain the definition of small-bowel wall thickening, analyze the patterns of involvement seen in multidetector computed tomography (MDCT) with intravenous contrast administration, and provide an image-based review of the different causes of small-bowel wall thickening. The differential diagnosis must include many entities because wall thickening can result from immune-mediated, infectious, or vascular causes, as well as from toxicity and other lesser-known entities. As the imaging appearance of many of these conditions overlap, clinical and laboratory findings are necessary to support the imaging diagnosis.

The CT scout view: complementary value added to abdominal CT interpretation

Computed tomography (CT) scout images, also known as CT localizer radiographs, topograms, or scanograms, are an important, albeit often overlooked part of the CT examination. Scout images may contain important findings outside of the scanned field of view on CT examinations of the abdomen and pelvis, such as unsuspected lung cancer at the lung bases. Alternatively, scout images can provide complementary information to findings within the scanned field of view, such as characterization of retained surgical foreign bodies. Assessment of scout images adds value and provides a complementary "opportunistic" review for interpretation of abdominopelvic CT examinations. Scout image review is a useful modern application of conventional abdominal radiograph interpretation that can help establish a diagnosis or narrow a differential diagnosis. This review discusses the primary purpose and intent of the CT scout images, addresses standard of care and bias related to scout image review, and presents a general systematic approach to assessing scout images with multiple illustrative examples, including potential pitfalls in interpreting scout images.

Intraperitoneal migration of a hookwire following wide local excision of a breast lesion presenting as a spontaneous pneumothorax

Hookwire migration is a rare complication of wide local excision surgery for breast neoplasia. We report the case of a 64-year-old woman who presented to hospital with acute on chronic left upper quadrant and left scapular pain. She had undergone a hookwire-guided wide local excision of a right breast neoplasm 5 years previously. Her vital signs, clinical examination and blood test were unremarkable. A CT scan revealed a left-sided pneumothorax and a 20 cm metallic intraperitoneal foreign body transpiercing the diaphragm. A review of the patient's clinical record revealed that she experienced a vagal collapse during hookwire implantation. This article underlines the importance of clear communication between members of a multidisciplinary team involved in a staged surgical intervention and exemplifies that foreign bodies can migrate across large distances, sometimes against gravity, to cross multiple anatomical compartments and cause iatrogenic injuries multiple years after an index intervention.

Risk factors and preventive strategies for unintentionally retained surgical sharps: a systematic review

BACKGROUND

A retained surgical item (RSI) is defined as a never-event and can have drastic consequences on patient, provider, and hospital. However, despite increased efforts, RSI events remain the number one sentinel event each year. Hard foreign bodies (e.g. surgical sharps) have experienced a relative increase in total RSI events over the past decade. Despite this, there is a lack of literature directed towards this category of RSI event. Here we provide a systematic review that focuses on hard RSIs and their unique challenges, impact, and strategies for prevention and management.

METHODS

Multiple systematic reviews on hard RSI events were performed and reported using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (Assessing the methodological quality of systematic reviews) guidelines. Database searches were limited to the last 10 years and included surgical "sharps," a term encompassing needles, blades, instruments, wires, and fragments. Separate systematic review was performed for each subset of "sharps". Reviewers applied reciprocal synthesis and refutational synthesis to summarize the evidence and create a qualitative overview.

RESULTS

Increased vigilance and improved counting are not enough to eliminate hard RSI events. The accurate reporting of all RSI events and near miss events is a critical step in determining ways to prevent RSI events. The implementation of new technologies, such as barcode or RFID labelling, has been shown to improve patient safety, patient outcomes, and to reduce costs associated with retained soft items, while magnetic retrieval devices, sharp detectors and computer-assisted detection systems appear to be promising tools for increasing the success of metallic RSI recovery.

CONCLUSION

The entire healthcare system is negatively impacted by a RSI event. A proactive multimodal approach that focuses on improving team communication and institutional support system, standardizing reports and implementing new technologies is the most effective way to improve the management and prevention of RSI events.

Diagnostic approach to small-bowel wall thickening: beyond Crohn's disease and cancer

Although small-bowel wall thickening is a common manifestation of Crohn's disease and tumors, many other entities can give rise to similar imaging findings. The small bowel is difficult to access by endoscopy, so radiologic imaging tests play an essential role in the diagnosis of conditions involving the small bowel. The main objectives of this paper are to explain the definition of small-bowel wall thickening, analyze the patterns of involvement seen in multidetector computed tomography (MDCT) with intravenous contrast administration, and provide an image-based review of the different causes of small-bowel wall thickening. The differential diagnosis must include many entities because wall thickening can result from immune-mediated, infectious, or vascular causes, as well as from toxicity and other lesser-known entities. As the imaging appearance of many of these conditions overlap, clinical and laboratory findings are necessary to support the imaging diagnosis.

Epiploic appendagitis of the vermiform appendix--An unusual mimic of acute appendicitis

Epiploic appendagitis is a condition resulting from ischemia or necrosis involving the appendage epiploica either due to torsion or spontaneous thrombosis of the venous outflow. It is one of the myriad causes of acute abdominal pain and can masquerade clinically as appendicitis, omental infarction, sclerosing mesenteritis and even diverticulitis. Epiploic appendagitis of the vermiform appendix is a rare entity, clinically indistinguishable from appendicitis. We present a 45-year-old male patient with 4-day duration of right iliac fossa pain and tenderness, with strong clinical suspicion of acute appendicitis. CT scan of the abdomen and pelvis demonstrated Epiploic appendagitis of the vermiform appendix, whilst the appendix remained uninflamed. The patient was thus discharged with conservative management without having to go undergo needless surgery, thereby avoiding the potential complications thereof.

Chest radiographs of cardiac devices (Part 1): Lines, tubes, non-cardiac medical devices and materials

Chest radiographs (CXRs) are the most common imaging investigations undertaken because of their value in evaluating the cardiorespiratory system. They play a vital role in intensive care units for evaluating the critically ill. It is therefore very common for the radiologist to encounter tubes, lines, medical devices and materials on a daily basis. It is important for the interpreting radiologist not only to identify these iatrogenic objects, but also to look for their accurate placement as well as for any complications related to their placement, which may be seen either on the immediate post-procedural CXR or on a follow-up CXR. In this article, we discussed and illustrated the routinely encountered tubes and lines that one may see on a CXR as well as some of their complications. In addition, we also provide a brief overview of other important non-cardiac medical devices and materials that may be seen on CXRs.

Ongoing Computed Tomography Appraisal of Intestinal Perforation Due to an Ingested Foreign Body

BACKGROUND Diagnosis and management of accidental or intentional ingestion of foreign bodies is a common problem at in emergency departments. This condition is generally observed in patients with limited consciousness or attention, such as children, elders, or psychiatric patients. Here, we report a case of intestinal perforation caused by ingestion of a foreign body that occurred during the performance of a contrast-enhanced CT scan. CASE REPORT A 73-year-old diabetic woman was admitted to the emergency room of our hospital with postprandial abdominal discomfort, nausea, and vomiting. Under the suspicion of bowel ischemia, the patient underwent a contrast-enhanced CT scan. A thickened ileal loop with an endoluminal bone-density foreign body was detected. The following contrast-enhanced acquisitions additionally showed air bubbles adjacent to the loop, as the sign of an intestinal perforation that occurred between the basal and the contrast-enhanced acquisitions. CONCLUSIONS Caution should be always exercised in patients with suspected gastrointestinal perforation, especially if caused by ingested foreign bodies. A high degree of suspicion and a CT scan may prevent delays in the diagnosis and clinical management of these patients.

Nontraumatic large bowel perforation: spectrum of etiologies and CT findings

Large bowel perforation is an abdominal emergency that results from a wide range of etiologies. Computed tomography is the most reliable modality in detecting the site of large bowel perforation. The diagnosis is made by identifying direct CT findings such as extraluminal gas or contrast and discontinuity along the bowel wall. Indirect CT findings can help support the diagnosis, and include bowel wall thickening, pericolic fat stranding, abnormal bowel wall enhancement, abscess, and a feculent collection adjacent to the bowel. Common etiologies that cause large bowel perforation are colon cancer, foreign body aspiration, stercoral colitis, diverticulitis, ischemia, inflammatory and infectious colitides, and various iatrogenic causes. Recognizing a large bowel perforation on CT can be difficult at times, and there are various entities that may be misinterpreted as a colonic perforation. The purpose of this article is to outline the MDCT technique used for evaluation of suspected colorectal perforation, discuss relevant imaging findings, review common etiologies, and point out potential pitfalls in making the diagnosis of large bowel perforation.

Imaging after treatment in uterine malignancies: Spectrum of normal findings and most common complications

Uterine malignancies account for the majority of gynaecologic cancers. Different treatment options are available depending on histology, disease grade and stage. Hysterectomy is the most frequent surgical procedure. Chemotherapy and radiation therapy (CRT) represents the preferred therapeutic choice for locally advanced uterine and cervical malignancies. Imaging of the female pelvis following these treatments is particularly challenging due to alteration of the normal anatomy. Radiologists should be familiar with both the expected post-treatment imaging findings and the imaging features of possible complications to make the correct interpretation and avoid possible pitfalls. The purpose of this review is to show the expected computed tomography (CT) and Magnetic Resonance Imaging (MRI) appearances of the female pelvis following surgery and CRT for uterine and cervical cancer, to illustrate the imaging findings of early and delayed most common complications after surgery and CRT, describing the suitable imaging modalities and protocols for evaluation of patients treated for gynaecologic malignancies.

Pre- and Postoperative Imaging of the Aortic Root

Three-dimensional datasets acquired using computed tomography and magnetic resonance imaging are ideally suited for characterization of the aortic root. These modalities offer different advantages and limitations, which must be weighed according to the clinical context. This article provides an overview of current aortic root imaging, highlighting normal anatomy, pathologic conditions, imaging techniques, measurement thresholds, relevant surgical procedures, postoperative complications and potential imaging pitfalls. Patients with a range of clinical conditions are predisposed to aortic root disease, including Marfan syndrome, bicuspid aortic valve, vascular Ehlers-Danlos syndrome, and Loeys-Dietz syndrome. Various surgical techniques may be used to repair the aortic root, including placement of a composite valve graft, such as the Bentall and Cabrol procedures; placement of an aortic root graft with preservation of the native valve, such as the Yacoub and David techniques; and implantation of a biologic graft, such as a homograft, autograft, or xenograft. Potential imaging pitfalls in the postoperative period include mimickers of pathologic processes such as felt pledgets, graft folds, and nonabsorbable hemostatic agents. Postoperative complications that may be encountered include pseudoaneurysms, infection, and dehiscence. Radiologists should be familiar with normal aortic root anatomy, surgical procedures, and postoperative complications, to accurately interpret pre- and postoperative imaging performed for evaluation of the aortic root. Online supplemental material is available for this article.

Sensitivity and Specificity of Emergency Physicians and Trainees for Identifying Internally Concealed Drug Packages on Abdominal Computed Tomography Scan: Do Lung Windows Improve Accuracy?

BACKGROUND

Suspected body packers may be brought to emergency departments (EDs) close to international airports for abdominal computed tomography (CT) scanning. Senior emergency clinicians may be asked to interpret these CT scans. Missing concealed drug packages have important clinical and forensic implications. The accuracy of emergency clinician interpretation of abdominal CT scans for concealed drugs is not known. Limited evidence suggests that accuracy for identification of concealed packages can be increased by viewing CT images on "lung window" settings.

OBJECTIVES

To determine the accuracy of senior emergency clinicians in interpreting abdominal CT scans for concealed drugs, and to determine if this accuracy was improved by viewing scans on both abdominal and lung window settings.

METHODS

Emergency clinicians blinded to all patient identifiers and the radiology report interpreted CT scans of suspected body packers using standard abdominal window settings and then with the addition of lung window settings. The reference standard was the radiologist's report.

RESULTS

Fifty-five emergency clinicians reported 235 CT scans. The sensitivity, specificity, and accuracy of interpretation using abdominal windows was 89.9% (95% confidence interval [CI] 83.0-94.7), 81.9% (95% CI 73.7-88.4), and 86.0% (95% CI 81.5-90.4), respectively, and with both window settings was 94.1% (95% CI 88.3-97.6), 76.7% (95% CI 68.0-84.1), 85.5% (95% CI 81.0-90.0), respectively. Diagnostic accuracy was similar regardless of the clinician's experience. Interrater reliability was moderate (kappa 0.46).

CONCLUSION

The accuracy of interpretation of abdominal CT scans performed for the purpose of detecting concealed drug packages by emergency clinicians is not high enough to safely discharge these patients from the ED. The use of lung windows improved sensitivity, but at the expense of specificity.

Giant peritoneal loose bodies

Giant peritoneal loose bodies are rare lesions, originating from auto-amputated appendices epiploicae. They may cause urinary or gastrointestinal obstruction and, should the radiologist not be familiar with the entity, can potentially be confused with malignant or parasitic lesions.Familiarity with their characteristic computed tomographic features is essential to prevent unnecessary surgery in the asymptomatic patient. We present a case of a 70-year-old man diagnosed with two giant peritoneal loose bodies.

Role of plain radiography in the assessment of ingested foreign bodies in the pediatric patients

Ingestion of various types of foreign bodies (FBs) such as coins, toy parts, jewelry pieces, needles and pins, fish and chicken bones, and button-type batteries is common among children. The curiosity of children and their need to investigate the world around them place them at a higher risk for ingestion of FBs. Fortunately, 80%-90% of ingested foreign objects that reach the stomach will pass uneventfully without intervention. The remainder may become blocked in the esophagus or other region of the alimentary tract, placing the pediatric patient at risk of significant complications such as aspiration, obstruction, bleeding, perforation, fistulization, sepsis, and death. The goals of the initial pediatric patient assessment are to identify the type of object ingested, its location in the gastrointestinal tract, and the presence of associated complications. Factors reported to increase the risk of complications included a sharp FB, a FB with a wide diameter, and symptoms. Plain radiographs still play an important role in the assessment of ingested FBs in the pediatric patient: plain films of the neck, chest, and abdomen are very useful in confirming the diagnosis of FB ingestion because most ingested FBs are radiopaque.

Imaging of abdominal and pelvic surgical and postprocedural foreign bodies

Every form of medical and surgical treatment, even the most trivial one, carries with it some chance of complications. This risk is usually small, and the benefit of the treatment should clearly outweigh the risk. Treatment-related complications may occur, however, presenting either soon after the intervention or remote from it. In this review, the focus is on imaging findings of surgical materials used in abdominal surgery, and of a wide array of implanted abdominal devices. The pertinent complications of these devices and of retained surgical objects are highlighted and illustrated.

Foreign bodies ingestion: what responsibility?

The ingestion of foreign bodies is one of the most important and difficult emergencies for a physician to diagnose. Accidental ingestion is more common in children, in patients with dental implants, in individuals with mental disability and in drug users. Voluntary ingestion is found in patients who are psychologically unstable, in prisoners or those who attempt suicide. Foreign bodies may be divided into food as fish bones, chicken bones, food bolus, meat, etc. or real foreign bodies such as orthodontic implants, needles, pins, glass, coins, etc. The authors present a case of management, from the medicolegal point of view, of a female patient age 80, who complained, for some weeks of modest pain in the left iliac fossa, and afterwards the endoscopy showed a toothpick into the wall of the sigmoid colon. Assessed of the clinical status of the patient presented severe cardiac comorbidities so that before processing the patient to a second resolutive endoscopy, it was necessary to obtain the hemodynamic stability. However the management of cases of accidental ingestion of foreign bodies is particularly difficult. Medical errors can arise from the very first contact with the patient resulting in delays in appropriate treatment. The doctor to avoid compromising its position on medical liability, must use all the knowledge and diligence known by the art and science of medicine.

Late presentation of unsafe abortion after 5 years of procedure

A majority of the unsafe abortions are performed by untrained birth attendants or quacks leading to complications in a large proportion of these cases. Complications like bowel injury, bladder injury, uterine perforation, and septic abortion are mostly caused by unskilled hands and are detected immediately or within few days of the procedure, owing to the need for tertiary level care. Here we present a very interesting case of unsafe abortion induced by a Ryle's tube in a 32-year-old lady, which was diagnosed five years after the procedure. Considering its atypical presentation, it is the first case of its kind in the literature. The details of the case and its management are described along with appropriate pictures.

Intestinal obstruction due to migration of a thermometer from bladder to abdominal cavity: A case report

Intraperitoneal foreign bodies such as retained surgical instruments can cause intestinal obstruction. However, intestinal obstruction due to transmural migration of foreign bodies has rarely been reported. Here, we report a case of intestinal obstruction due to a clinical thermometer which migrated from the bladder into the abdominal cavity. A 45-year-old man was admitted to our hospital with a one-year history of recurrent lower abdominal cramps. Two days before admission, the abdominal cramps aggravated. Intestinal obstruction was confirmed with upright abdominal radiography and computerized tomography scan which showed dilation of the small intestines and a thermometer in the abdominal cavity. Then laparotomy was performed. A scar was observed at the fundus of the bladder and a thermometer was adhering to the small bowels and mesentery which resulted in intestinal obstruction. Abdominal cramps were eliminated and defecation and flatus recovered soon after removal of the thermometer.

T. Multidetector-row computed tomography in the preoperative diagnosis of intestinal complications caused by clinically unsuspected ingested dietary foreign bodies: a case series emphasizing the use of volume rendering techniques

Objective The present study was aimed at describing a case series where a preoperative diagnosis of intestinal complications secondary to accidentally ingested dietary foreign bodies was made by multidetector-row computed tomography (MDCT), with emphasis on complementary findings yielded by volume rendering techniques (VRT) and curved multiplanar reconstructions (MPR). Materials and Methods The authors retrospectively assessed five patients with surgically confirmed intestinal complications (perforation and /or obstruction) secondary to unsuspected ingested dietary foreign bodies, consecutively assisted in their institution between 2010 and 2012. Demographic, clinical, laboratory and radiological data were analyzed. VRT and curved MPR were subsequently performed. Results Preoperative diagnosis of intestinal complications was originally performed in all cases. In one case the presence of a foreign body was not initially identified as the causal factor, and the use of complementary techniques facilitated its retrospective identification. In all cases these tools allowed a better depiction of the entire foreign bodies on a single image section, contributing to the assessment of their morphology. Conclusion Although the use of complementary techniques has not had a direct impact on diagnostic performance in most cases of this series, they may provide a better depiction of foreign bodies' morphology on a single image section.

Dropped gallstones: spectrum of imaging findings, complications and diagnostic pitfalls

Spillage of gallstones into the abdominal cavity, referred to as "dropped gallstones" (DGs), occurs commonly during laparoscopic cholecystectomy. The majority of these spilled stones remain clinically silent; however, if uncomplicated DGs are not correctly identified on subsequent imaging, they may mimic peritoneal implants and cause unduly concern. A small percentage of DGs cause complications, including abscess and fistula formation. Recognising the DG within the abscess is critical for definitive treatment. This pictorial review illustrates the imaging appearances and complications of DGs on CT, MRI and ultrasound and emphasises pitfalls in diagnosis.

What is the role of plain radiography in patients with foreign bodies in the gastrointestinal tract?

Foreign bodies (FBs) in the gastrointestinal (GI) tract can show a wide range of clinical manifestations ranging from spontaneous evacuation to severe complication. Plain radiography is a straightforward and important initial imaging modality in cases of FB ingestion or insertion and is also helpful for follow-up purposes. Careful evaluations of the plain radiographs can determine the presence and nature of FBs, and help predict their precise locations and facilitate risk assessment. In this review, a wide variety of FBs in the GI tract are illustrated, and the role of plain radiography in patient management is discussed.