Delayed ileal perforation following lollipop-stick ingestion in a two year old

Abstract

An ileal perforation caused after ingesting a foreign object is a rare, life-threatening complication that requires surgical intervention. We report a case of ileal perforation in a 2-year-old girl who presented to the pediatric emergency department unconscious with acute abdominal symptoms of unknown etiology 6 months after ingesting a lollipop plastic stick. Her symptoms progressed to shock and loss of consciousness over one day. A laparotomy performed after achieving hemodynamic stabilization was both diagnostic and curative. This is the first reported case of ileal perforation in children due to ingesting a lollipop stick. The hollow interior of the stick may have facilitated the passage of larger amounts of gas into the peritoneum, resulting in the detection of pneumoperitoneum on an erect abdominal film, which is rarely detected on simple abdominal films and may not show up even on computed tomography. The critical presentation of the patient in our case emphasizes the need to consider the often neglected foreign-body-induced perforation as part of the differential diagnosis and to recognize the characteristic early signs and symptoms of deterioration. Furthermore, the importance of comprehensive history taking, which includes a serious investigation of any previous incidents of foreign body ingestion, cannot be overstated. • A lodging lollipop stick induced intestinal perforation at the level of the terminal ileum, six months after ingestion. • Even though CT scan is considered the gold standard approach in cases of foreign body ingestion, X-Ray imaging in our case offered a fast, cheap, and reliable clinical tool that was accurate enough to allow for deciding laparotomy as the next step in management. • Laparotomy was both diagnostic and curative. • We recommend against a passive wait-and-see approach in cases of ingestion associated with foreign objects that are sharp, pointed, and/or elongated. • The physical attributes of the ingested foreign object could have interesting effects on the overall clinical picture.