A caecal perforation from foreign body ingestion in a child with autistic spectrum disorder

Abstract

Foreign body ingestion is a common medical issue. However, quite often the diagnosis of foreign body ingestion can be a challenge as clinical presentation is variable, often with non-specific symptoms. It is reported that 80- 90% of ingested foreign bodies can pass through the gastrointestinal tract without any clinical sequalae; rarely, 1%, cause bowel perforation. This report presents the case of a 13-year-old boy with autistic spectrum disorder brought in by his parents with undifferentiated abdominal pain and non-specific symptoms including recent flu-like symptoms, generalised weakness, and lethargy. It was difficult to obtain a thorough history and examination due to his developmental disorder. Diagnostic laparoscopy was subsequently conducted and an unexpected finding of a caecal perforation from an ingested metal wire was noted. Primary closure of the caecal perforation was performed post metal wire removal. The patient recovered well with no post-operative complications. As clinicians, we should have a high index of suspicion for foreign body induced viscus perforation when patients present with atypical abdominal pain, especially in those with paediatric developmental disorders such as autism. Patients with autism often increase the difficulty of clinical diagnosis due to poor history taking and a challenging physical examination. Overall, an emergency diagnostic laparoscopy is recommended if the patient has any suspicion of an acute abdomen.