Appendicitis-mimicking presentation in fishbone induced microperforation of the distal duodenum: A case report

Perforated appendicitis due to fishbone

Appendicitis is a common condition in daily clinical practice. Appendicitis due to foreign bodies is uncommon and may result from obstruction or perforation mechanism. We present a rare case of a 43-year-old male patient who was diagnosed with perforated appendicitis due to a fish bone by imaging studies and confirmed postoperatively. Confirming the fish bone causing the perforation on images is sometimes difficult, requiring the radiologist to actively search and determine the source. In addition to appendectomy, the surgeon also needs to pay attention to removing all foreign objects and treating perforations of surrounding organs.

Abdominal pain from ingested bone misdiagnosed as appendicitis: Report of a rare case and literature review

Bones are potential foreign bodies that could be accidentally ingested, leading to several symptoms varying from asymptomatic to perforation of the gastrointestinal tract. However, these cases are rare but may be misdiagnosed with other common diseases such as appendicitis. We present in this case a 25-year-old male who presented with appendicitis symptoms, after appendectomy the patient had the same complaint, But the colonoscopy demonstrated a meat bone in the terminal ileum and was removed with the same device. Finally, he was discharged from the hospital without complications and after decreasing abdominal pain. According to the literature review, this is one of the rare cases of using colonoscopy to treat bone impaction non-operatively.

Augmented reality navigation facilitates laparoscopic removal of foreign body in the pancreas that cause chronic complications

BACKGROUND

Foreign bodies that enter the pancreas and cause chronic complications cannot be removed by endoscopy. Surgical removal is necessary but also challenging. The development of augmented reality navigation has made it possible to accurate intraoperative navigation in laparoscopic surgery.

METHODS

A 37-year-old female had epigastric pain for 3 months and her abdominal CT showed a linear high-density shadow in her pancreas along with chronic pancreatitis. Three-dimensional models of the liver, pancreas, stomach, blood vessels, and foreign body were created based on CT images. Gastroptosis was found in the three-dimensional models, so surgical approach was adapted to open the hepatogastric ligament to reach the pancreas. After 2-3 s of video images were captured by 3D laparoscopy, a three-dimensional dense stereo-reconstruction method was used to obtain the surface model of pancreas, stomach, and blood vessels. The Globally Optimal Iterative Closest Point method was used to obtain a spatial transformation matrix between the preoperative CT image space and the intraoperative laparoscopic space. Under augmented reality navigation guidance, the position and location of the foreign body were displayed on the surface of the pancreas. Then intraoperative ultrasound was used for further verification and to quickly and easily confirm the surgical entrance. After minimal dissection and removal of the pancreatic parenchyma, the foreign body was removed completely.

RESULTS

The operation time was 60 min, the estimated blood loss was 10 ml. The foreign body was identified as a 3-cm-long fishbone. The patient recovered without complications and was discharged on the third postoperative day.

CONCLUSION

Because it enables direct visual navigation via simple operation, ARN facilitates the laparoscopic removal of foreign bodies in the pancreas with accurate and rapid positioning and minimal damage.