A Rare Complication of an Ingested Foreign Body: Back Pain

Abstract

Generally patients do not recall ingesting a foreign body and this is usually detected on radiological imaging studies, during surgery or in the pathological examination of the surgical specimens. Ingested foreign bodies usually present with non-specific symptoms and different clinical symptoms may occur in patients. Abdominal pain is the most common complaint (95%), followed by fever (81%) and localized peritonitis (39%). A 61 year old male with history of coronary artery disease, liver cirrhosis from chronic hepatitis C, alcohol abuse, complained of left lower back pain for over two years with no radiation, no history of trauma and no associated lower extremity weakness or paresthesia. The patient saw a urologist for evaluation of gross hematuria which he has had for over a year. CT urography revealed a large linear radiopaque foreign body in the mid sigmoid colon. Colonoscopy showed a foreign body (bone) in the sigmoid colon (figure 1). Removal of bone was accomplished with a rat-toothed forceps and snare (figure 2). Patient's left lower back pain resolved after removal of the chicken bone. On literature review, back pain has not been reported as a complication of an ingested foreign body. Besides abdominal pain, fever and localized peritonitis, other symptoms that may occur are nausea, vomiting, hematochezia and melena. Bowel perforation and acute surgical abdomen can lead to misdiagnosis with other conditions causing surgical abdominal diseases, such as acute appendicitis, diverticulitis or perforated peptic ulcer. Gastric, duodenal or colonic perforations can present as more chronic events, such as abdominal mass or abscess. The limitation of this report is probably the fact that the patient did not have any imaging studies of his back done to rule out other etiologies of his back pain. The bone was located near the junction of the descending colon and sigmoid colon and may have been causing pain due to it's proximity to the retroperitoneal space. Both ends of the piece of bone were lodged in diverticula which held up the bone in the colon.1471_A Figure 1. CT urography reveals a large linear radiopaque foreign body in the mid sigmoid colon.1471_B Figure 2. Colonoscopy showed a foreign body (bone) in the sigmoid colon.