S2496 Endoscopic Source Control of Gram-Negative Bacteremia Secondary to Foreign Body Ingestion - A Rare Case

Abstract

Introduction: Foreign body (FB) ingestion is usually observed in the pediatric population; however, adult cases of FB ingestion are not uncommon. Usual FB culprits seen in adults include fish bones, chicken bones, and dentures. Possible complications include dysphagia, complete occlusion with risk of aspiration, and perforation. Such complications warrant retrieval of FB via endoscopic removal or surgical on case-to-case basis. We present a very rare case of FB ingestion resulting in bacteremia necessitating endoscopic removal leading to source control. Case Description/Methods: The patient is a 58-year-old male with a past medical history of diabetes mellitus, hypertension, and chronic venous stasis. He was initially admitted for sepsis secondary to cellulitis and had to be readmitted due to cultures from the initial admission being positive for slow-growing gram-negative anaerobic rods (GNAR). The most common sources of GNAR are recognized to be genitourinary and gastrointestinal in origin. The patient had no history of benign prostatic hyperplasia, and denied any urinary complaints, with negative urine cultures from the initial admission. The patient did not have any abdominal complaints either; however, cross-sectional abdominal imaging was obtained to assess for any intra- abdominal collections/abscess, which surprisingly showed a 5.3 cm tubular radiopaque focus in the cecum suggestive of a foreign body. Blood cultures from the second admission also grew GNAR, which speciated into capnocytophaga. Gastroenterology was consulted to assist with endoscopic evaluation of this finding with possible retrieval of the foreign body. Colonoscopy was attempted and a chicken bone was found in the cecum which was successfully removed with a snare. Possible inflammation of this bowel segment from cecal trauma could have resulted in transient translocation of the bacteria from the cecum with resultant bacteremia. Subsequent blood cultures after FB removal were negative suggesting adequate source control. Discussion: GNAR bacteremia warrants workup for genitourinary and gastrointestinal sources. Our case highlights a rare clinical scenario where FB ingestion led to GNAR bacteremia. Though this is a very rare phenomenon, clinicians investigating the causes of GNAR bacteremia should have a broad differential in cases where the culprit is not obvious. Timely identification of the GNAR source and its control is very crucial in treating such population.