Preoperative roentgen demonstration of non-opaque foreign body in the duodenum; report of a case.

Abstract

The roentgendemonstration of opaque foreign bodies in the gastrointestinal tract is a common occurrence. This is especially true in children who swallow metallic objects, which are usually followed for a few days and passed naturally without event. Demonstration of non-opaque foreign bodies, on the other hand, is a much rarer occurrence and correspondingly more difficult. Their presence is usually suspected only after the occurrence of an abdominal catastrophe, necessitating emergency surgical intervention. A common manifestation of the presence of a foreign body in the alimentary tract is intestinal obstruction, bezoars of different varieties being the most commonly reported offenders (1). Ingested dried fruit has been implicated, and even a distended condom has been found in a patient with intestinal obstruction (2). The other serious complication has been intestinal perforation. The most frequently reported causes of perforation are the radiopaque chicken and fish bones. Of non-opaque foreign bodies causing perforation, the common wooden toothpick has been previously reported (3 and 4). A review of the general medical and radiological literature for the past twelve years fails to reveal any instance in which the diagnosis of a non-opaque foreign body within the intestine was made by roentgen methods before the development of major complications. This, of course, does not include the not infrequent cases of worm infestation demonstrated with the aid of the barium meal. The present case is reported because of the roentgenologic demonstration of an intra-intestinal non-opaque foreign body (toothpick) in the absence of a helpful clinical history and before the need for surgical intervention became clinically apparent. It also presents a somewhat unusual symptom complex which might have been considered functional in the absence of positive roentgenologic findings. Case R. V., a 25-year-old white mechanic, was first seen in the Lynn Clinic on Aug. 13, 1951, complaining of recurrent transient abdominal pains. He had been well until three weeks previously. The pain seemed to start in the right lower quadrant and then spread to the flanks and periumbilical region. The discomfort lasted only a few minutes and disappeared only to recur after an unpredictable asymptomatic interval. There was no rhythmicity to the pain and it bore no relation to food or food types. There was no associated nausea, vomiting, or change in bowel habit. Melena had not been present at any time. The past history was of no significance. There had been no abdominal surgery. The family history was non-contributory.