Intestinal Obstruction Caused by an Unusual Foreign Body

Abstract

Case Report. J. L., a forty-two year old unmarried white male was admitted June 22, 1948 complaining of abdominal pain and vomiting. He had been well until six hours prior to admission when, while working at a power press, he was suddenly seized with severe intermittent cramp-like abdominal pain, worse in the right lower quadrant, and the vomiting of clear yellow fluid. Upon admission his rectal temperature was 101.8°F; pulse 115 per minute, regular; respirations 22 per minute. He was markedly dehydrated and in severe pain. The abdomen was slightly distended and tender throughout, with muscle spasm in the lower half. The maximum tenderness was in the right lower quadrant. The blood and urine were normal. A tentative diagnosis was made of acute appendicitis and the patient was operated on. The appendix was slightly reddened and swollen, but did not appear to be the cause of the patient's trouble. The gallbladder, gastroduodenal and colonic regions seemed to be normal. Several inches of terminal ileum were reddened, swollen and edematous with moderate thickening of the intestinal wall. While palpating this area of intestine there was noted a small localized distended area of terminal ileum which could not be propelled toward the cecum. This was interpreted as being a small loculation of air and intestinal fluid entrapped in the lumen. There was no dilated intestine proximally, nor was there collapsed intestine distally, and a diagnosis of intestinal obstruction was therefore not considered. The assumption was that we were dealing with a mild case of regional ileitis with a good chance for resolution. An appendectomy was done and the abdomen closed. The postoperative course was consistent with regional ileitis. Distention, pain, and vomiting were present, requiring the use of Wangensteen suction. The temperature gradually rose each evening to reach a maximum of 105°F on the fourth postoperative day. On the sixth postoperative day the patient passed many copious brown liquid stools. The abdomen receded somewhat and the patient felt better. However, this condition of marked relief from the obstruction did not last very long, and the patient was again troubled with distention, and intervals of frequent liquid brown stools. Even though it was possible to remove the Miller-Abbott tube ten