Ingested bone fragment in the bowel: Two cases and a review of the literature

Toothpick: An Unusual Cause of Small Bowel Perforation in an Adult

Foreign body ingestion is a common complaint in the pediatric population; however, in adults, this entity remains quite rare. Most cases are managed conservatively with serial examinations and imaging. Rarely, foreign body ingestion may cause small bowel perforation and peritonitis in adults. Perforation often warrants operative management, and assessment of bowel viability is crucial. Here, we present a case of foreign body ingestion requiring exploration, without the need for bowel resection or repair. Although the need for operative intervention in adults after foreign body ingestion remains rare, it is crucial to recognize those patients who are both at risk for foreign body ingestion and have underlying small bowel narrowing that puts them at risk for perforation. A high index of suspicion in these instances is mandatory as early recognition and appropriate treatment will improve outcomes.

A Right-Angled Thorn in the Bowel: A Curious Case of Small Bowel Perforation

We present a 45-year-old man with small bowel perforation resulting from the inadvertent ingestion of a right-angled thorn of the Gum Arabic plant (Vachellia nilotica). The diagnosis was made, and an emergency laparotomy was performed for suspected enteric peritonitis. The thorn was found projecting from the terminal ileum with a minimal intra-peritoneal fluid collection. The thorn was removed, and the perforation site was repaired primarily with absorbable sutures. The lack of a reliable history of foreign body ingestion makes it impossible to arrive at an accurate preoperative diagnosis in patients presenting with perforation peritonitis. Radiological investigations have a low sensitivity for detecting radiolucent vegetative foreign bodies as the cause of bowel perforations. Primary repair should be preferred over resection procedures in the management of foreign body-induced small bowel perforations.

Misdiagnosis of food-borne foreign bodies outside of the digestive tract on magnetic resonance imaging: Two case reports

BACKGROUND

Patients with foreign bodies in the digestive tract are often encountered, but complete penetration of a foreign body through the gastrointestinal tract is rare, and the choice of imaging method is very important. Improper selection may lead to missed diagnosis or misdiagnosis.

CASE SUMMARY

An 81-year-old man was diagnosed as having a liver malignancy after he took magnetic resonance imaging and positron emission tomography/computed tomography (CT) examinations. The pain improved after the patient accepted gamma knife treatment. However, he was admitted to our hospital 2 mo later due to fever and abdominal pain. This time, he received a contrast-enhanced CT scan, which showed fish-boon-like foreign bodies in the liver with peripheral abscess formation, then he went to the superior hospital for surgery. It lasted for more than 2 mo from the onset of the disease to the surgical treatment. A 43-year-old woman with a 1 mo history of a perianal mass with no obvious pain or discomfort was diagnosed as having an anal fistula with the formation of a local small abscess cavity. Clinical perianal abscess surgery was performed, and fish bone foreign body was found in perianal soft tissue during the operation.

CONCLUSION

For patients with pain symptoms, the possibility of foreign body perforation should be considered. Magnetic resonance imaging is not comprehensive and that a plain computed tomography scan of the pain area is necessary.

Ingested Chicken Bone (Xiphoid Process) in the Anal Canal: A Case Report and Literature Review

Accidental foreign body (FB) ingestion is common in the elderly, particularly edentulous and denture wearers. The most commonly ingested FBs are food-related, including fish and chicken bones. While small FBs can pass through the gastrointestinal tract without any complications, large or irregular-shaped FBs usually cause complications. These complications include choking, ulceration, perforation, fistula, abscess formation, or even death. Ingestion of a large chicken bone that reaches the anal canal without causing injury is extremely rare. We present a rare case of accidental chicken bone (xiphoid process) ingestion that manifested itself by projecting from the anus while defecating. Interestingly, the patient did not experience any food choking or abdominal pain, nor did she have any type of dementia. However, the patient could not grind food properly due to the loss of her upper molar teeth, which made her develop a habit of rapid swallowing. On examination, the chicken bone was seen within the anus with a sharp edge embedded in the mucosal wall. While a plain pelvic X-ray failed to display the FB, a pelvic CT scan with a 3D illustration showed its dimensions (5.0 x 2.5 x 3 cm). A plain pelvic CT scan confirmed the presence of the bone-contrast FB within the anal canal without injuring the surrounding anatomical structures. The FB was gently manipulated and successfully extracted after administering 5 ml of lidocaine gel enema. The patient was counseled regarding proper chewing habits, and she was referred to a dental clinic for a professional assessment. Seven days later, the patient was seen again at the clinic for a follow-up and was found to have an uneventful recovery. Maintaining good dental health and proper eating habits, as well as increasing awareness among edentulous individuals and denture wearers, are required to prevent accidental FB ingestions.

A fatal perforation of the distal ileum from an ingested fish bone: A case report

INTRODUCTION AND IMPORTANCE

Foreign body-induced perforations of the ileum are rare consequences among adults.

PRESENTATION OF CASE

This is a case report of a delayed presentation of an ileal perforation and concurrent faecal peritonitis presented as an acute abdomen, resultant from an ingested fishbone, which led to fatality despite urgent laparotomy.

CLINICAL DISCUSSION

Perforations following ingested foreign bodies are frequently unanticipated clinically, and diagnosed during advanced imaging studies or surgical interventions. Endoscopy, laparoscopy, and laparotomy have been used during surgical management in reported cases; however, prior early identification is pivotal for good outcomes as delayed presentations and delayed diagnosis carry a poorer prognosis.

CONCLUSION

Despite fish bones being frequent foreign bodies in the gastrointestinal tract and the majority causing no life-threatening adverse effects, they are the leading foreign bodies instigating gastrointestinal perforations. A high degree of suspicion is required when attending to patients with suspected gastrointestinal perforations and absent typical findings in routine imaging, where fish bones could be the aetiology.

Gastrointestinal perforations by ingested foreign bodies: A preoperative diagnostic flowchart-based experience. A case series report

Background

Methods

Results

Conclusions

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The diagnosis is rarely established preoperatively, as most patients do not recall or disclose ingesting a FB.

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The flowchart makes it possible to suspect the diagnosis in the emergency room.

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Our experience shows that the use of a diagnostic algorithm greatly improves management.

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It is hoped that our experience will encourage other teams to develop diagnostic and even therapeutic flowcharts.

Intestinal perforation caused by fishbone in a child with the misdiagnosis of acute appendicitis: A case report

If a child has abdominal pain, it is important to evaluate the possibility of intestinal perforation caused by foreign objects such as fishbone. If a foreign agent is present, laparoscopic surgery is an effective method to remove the foreign objects.

Ingested a fish bone-induced ileal perforation: A case report

INTRODUCTION

Gastrointestinal perforation due to foreign body intake is rare and often secondary to unintentional intake; hence, a misdiagnosis is likely. Herein, we report a case of perforation of the ileum due to fish bone.

CASE PRESENTATION

A 57-year-old woman presented with right lower abdominal pain. She did not provide any information about having a history of swallowing foreign bodies. Surgery for uterine fibroids and subtotal gastrectomy was performed 6 years ago.

DIAGNOSIS

Laboratory tests and imaging examination showed normal results. During laparotomy, a fish bone was found at the end of the ileum. Two senior radiologists re-evaluated the computed tomography scan, and confirmed the presence of the suspected foreign body.

INTERVENTIONS

Partial intestinal resection and manual ileum end anastomosis were performed.

OUTCOMES

The patient recovered well after surgery and recalled that she had eaten fish the night before experiencing abdominal pain.

CONCLUSION

An accurate diagnosis of complications due to fish bone intake, often secondary to the unintentional intake, is quite challenging. Detailed history-taking about the patient's diet and eating habits is therefore important. Clinical manifestations are mainly determined by the location of perforation, which typically occurs at the junction of the ileum and rectal sigmoid colon. Imaging examination and surgery are often used for definite diagnosis.

Gastric Perforation after Chicken Bone Ingestion

Chicken bone ingestion is a common occurrence that usually passes uneventfully through the digestive tract and rarely results in complications such as perforation, which occurs very rarely within the stomach. We report here a case of a chicken bone ingestion resulting in gastric perforation, which ultimately required surgical correction.

Foreign Body Ingestion Causing Recurrent Diverticulitis

Patient: Male, 73

Final Diagnosis: Foreign body causing recurrent diverticulitis

Symptoms: Chronic abdominal pain

Medication: —

Clinical Procedure: —

Specialty: Gastroenterology and Hepatology

A prospective study of epidemiological risk factors for ingestion of fish bones in Singapore

INTRODUCTION

Ingestion of fish bones is a common clinical complaint among adult patients. The aim of this study was to evaluate the epidemiological and behavioural risk factors for fish bone ingestion.

METHODS

Between 2009 and 2010, a physician-administered questionnaire was administered to 112 consecutive patients who presented to the emergency department of an adult tertiary hospital with the complaint of fish bone ingestion.

RESULTS

The wearing of dentures, the use of utensils to eat fish and the practice of deboning fish in one's mouth were found to be associated with an increased risk of fish bone ingestion.

CONCLUSION

To prevent the occurrence of fish bone ingestion and its possible complications, at-risk populations should be advised on the precautions to take when eating boned fish.

Case of unrecognised food bone ingestion with dual site intestinal perforations

Food bone perforation of the bowel is a relatively rare diagnosis. Its presentation is non-specific and often misdiagnosed. We present a case where a food bone perforation in both the large and small bowel was diagnosed on CT scan. A successful outcome was achieved with surgical treatment.

Perforation of the gastrointestinal tract caused by inadvertent ingestion of blister pill packs: report of two cases diagnosed by MDCT with emphasis on maximal intensity and volume rendering reformations

We report two cases of elderly patients presenting with life-threatening complications due to inadvertent accidental ingestion of blister pill packs (BPPs). The first patient presented with obstruction followed by anemia and finally perforation of the small bowel. The second presented with rapidly lethal mediastinitis due to a large perforation of the lower esophagus. The responsible BPPs were identified by multidetector computed tomography and the best result in their characterization was obtained through maximal intensity projections and volume rendering reformations.