Back from the Bread: Delayed Presentation of an Ingested Foreign Body

Abstract

Background: Foreign body ingestion is often uneventful and rarely requires surgical intervention. It can however become problematic, predominantly affecting the gastrointestinal tract or more rarely the genitourinary tract. Few cases of the latter have been described. Objective: The aim of this case report is to raise awareness of the potentially indolent presentation of foreign body ingestion resulting in urological complications. Method: We report a unique case of a forty year old presenting with suprapubic pain, urgency and frequency twenty years following inadvertent ingestion of a needle. Results: Following initial investigation for common causes of lower urinary tract symptoms, ultrasound and computer tomography located the needle within a perivesical cavity associated with the bladder dome. Attempted removal via laparoscopy and open approach was unsuccessful. The patient ultimately underwent robotic assisted laparoscopic partial cystectomy in order to excise the cavity and foreign body. Conclusion: Extra-luminal migration of foreign bodies from the gastrointestinal to the genitourinary tract is rare but should be considered as a differential for urological symptoms in difficult cases when the aetiology remains elusive. Access to radiological imaging remains vital to enabling verification of the diagnosis. Optimal management involves localisation and excision of the foreign body and any containing cavity or fistulae. This may require advanced techniques including intra-operative imaging and a robotic-assisted laparoscopic approach.