EP-570 Rare case of pre-pyloric perforation of stomach secondary to foreign body ingestion

Abstract

Abstract Background Gastrointestinal perforation remains a common cause of acute abdomen in clinical practice. However, pre-pyloric perforation secondary to ingested foreign body (FB) in the adult population is rare. Nearly 80–90% of ingested foreign bodies will pass through the GI system spontaneously with only 1% requiring surgery. We report a rare incidence of pre-pyloric perforation in a patient unaware of ingestion of any foreign body. Case presentation A 59 year old female with no medical history, presented to the ED department with severe epigastric pain, vomiting and fever. She had a peritonitic abdomen and corroborative inflammatory markers. An urgent computed tomography scan demonstrated a 7×5cm collection near the transverse colon and a linear streak of hyperdense material near the collection. Patient had no recollection of ingestion of FB. Diagnostic laparoscopy followed by laparotomy, revealed inflammation and necrotic adipose tissue between the transverse colon and stomach walling of a purulent cavity. A 2cm shard of glass was retrieved. Examination of the posterior wall of the stomach eventually located the site of perforation. Generous washout, debridement and suture repair with omental plug was performed. She made an uneventful recovery. Conclusion Sharp objects do not pass via the pylorus easily and can cause perforation in the proximal part of gastrointestinal tract. Any features of complication mandates exploration and examination of the posterior surface of the stomach is quintessential