Accidental Ingestion Of Foreign Bodies Research Articles

RECTAL PERFORATION COMPLICATED BY FOURNIER’S GANGRENE SECONDARY TO ACCIDENTAL TOOTHPICK INGESTION

SESSION TITLE: Case Report Semifinalists 9 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Necrotizing fasciitis (NF) is a life threatening soft-tissue infection. Fournier’s Gangrene (FG) is NF involving the genital, perianal and perineal regions. Accidental Foreign body (FB) ingestion resulting in life threatening NF and FG is extremely rare. We report one such interesting case. CASE PRESENTATION: A 57-year-old male with past medical history of diabetes mellitus presented with chief complaints of vomiting, non-bloody diarrhea and rectal pain. Physical exam was remarkable for high grade fever and normal digital rectal exam. Laboratory investigations were remarkable for leukocytosis with negative infectious workup and autoimmune panel. CT abdomen/pelvis was suggestive of proctitis. The patient was started on broad spectrum antibiotics. He continued to spike high grade fevers with up trending leukocytosis, followed by hypotension and new onset painful bilateral testicular swelling . CT pelvis of soft tissues showed a peri-rectal opacity, massive subcutaneous edema, air in the perineum and scrotum with extension to the right lateral aspect of the anus concerning for FG. The patient underwent sigmoidoscopy followed by local exploration via a peri-rectal incision. A toothpick 3.1 x 0.2 x 0.1 cm was found to have perforated the rectum 6cm from the anal sphincter forming a fistulous connection, with perirectal abscess and extending cephalad to the base of the scrotum. The patient had multiple debridements and eventually underwent sigmoid colostomy. A follow up colonoscopy at eight months showed recovery from the perforation and the colostomy was closed electively. DISCUSSION: Accidental ingestion of a foreign body (FB) is not uncommon. FB has been reported to cause bleeding, obstruction, perforation, fistula formation and in rare cases necrotizing fasciitis (NF). Symptoms, complications and site of lodgment depends on size and sharpness of the FB and frequently involve the duodenum (23%) and large intestine (37%). Less than 1 % FB cause perforation. Investigation modalities include plain film, ultrasound, CT scan and MRI. Broad-spectrum antibiotics, surgical debridement and control of the perforation are imperative in the management of cases like our patient. The option for stoma creation versus primary colonic repair depends on severity of the perforation and the patient’s general condition. It should be noted that while cases of intestinal perforations secondary to diverticulitis or gastrointestinal tract malignancies resulting in NF are not uncommon. To the best of our knowledge, this is the third case in literature of NF and FG caused by accidental tooth pick ingestion. CONCLUSIONS: This case brings to light an interesting and rare presentation of accidental tooth pick ingestion leading to life-threatening FG. Reference #1: Intestinal Perforation by a Toothpick as Reason for Necrotizing Fasciitis. Markus Rupp, Gero Knapp, David Weisweiler, Christian Heiss, Volker Alt. J Bone Jt Infect. 2018; 3(4): 226–229. Reference #2: Right Hip Necrotizing Fasciitis. Lee I-H, How C-K, Chen J-D, Yen DH-T, Chiu Y-H. N Am J Med Sci. 2011;341:499 Reference #3: Necrotizing fasciitis. Green RJ, Dafoe DC, Rajfin TA. Chest. 1996;110:219–29. DISCLOSURES: No relevant relationships by Andrey ILiev, source=Web Response No relevant relationships by Muneer Khan, source=Web Response No relevant relationships by Mariam Saeed, source=Web Response

Duodenal perforation nine months after accidental foreign body ingestion, a case report

BackgroundForeign body ingestion is a scenario occasionally encountered in the emergency room. Pediatric and psychiatric patients are the two most common populations suffering from accidental or in some cases intentional ingestion of foreign bodies. Commonly, majority of cases require no specific treatment and the swallowed objects pass through the digestive tract spontaneously without causing any significant complications. Less than 1% of the cases complicates with gastrointestinal tract perforation, which are often caused by sharp objects, which warrants surgical intervention. The average time from foreign body ingestion to development of perforation was noted at 10.4 days in previous reports. These cases often present in rapidly progressing peritonitis and are subsequently managed by emergent laparotomy. In this case report, we describe an accidental chopstick ingestion of a patient who initially was misdiagnosed and remained asymptomatic for nine months, then presented with acute abdomen.Case presentationA 27-year-old man accidentally ingested a wooden chopstick and sought consult at a clinic. Negative abdominal plain film misled the physician to believe ingested chopstick was digested into fragments and passed out unnoticed. The patient presented acute abdomen caused by duodenal perforation nine months later and was subsequently treated with emergency laparotomy with primary duodenorrhaphy.ConclusionsNegative plain films are not sufficient to conclude a conservative treatment in foreign body ingestion. Computed tomography scan or endoscopic examinations should be done to rule out retained foreign body within gastrointestinal tract.

Spectrum of imaging findings in trans-gastric migration of accidently ingested metallic foreign bodies

Background: An accidently ingested foreign body may get lodged within the lumen of gastrointestinal tract, pass uneventfully with feces or may migrate extraluminally into the surrounding tissues in which case it may lead to suppurative or vascular complications. The aim of the endeavor was to study the spectrum of imaging findings in patients with accidental ingestion of foreign bodies with trans-gastric migration of metallic foreign bodies.Methods: Total 33 patients with history of accidental ingestion of foreign bodies were subjected to preliminary radiograph of neck, chest and abdomen followed by upper gastrointestinal endoscopy. Failure to retrieve/ localize foreign body endoscopically from upper gastrointestinal tract with check radiograph reiterating the presence of foreign body in upper abdomen were subjected to computed tomography of abdomen.Results: A total of 33 patients comprising of 27 females and 6 males with mean age of 23.76 years with history of foreign body ingestion were studied. Ingested foreign bodies were lodged in pharynx (n=7), esophagus (n=3), stomach (n=13) or duodenum (n=3). In 7 patients in whom endoscopy failed to locate and/or retrieve foreign body, computed tomography confirmed the presence of trans-gastrically migrated foreign body in the surrounding structures. The location of migrated foreign bodies was in lesser sac (n = 2), greater omentum (n = 3), lesser omentum (n = 1) and transmural (n = 1). Two patients had evidence of collection formation around the migrated foreign bodies.Conclusions: Sharp or pointed metallic foreign bodies may migrate trans-luminally with various implications. Though radiography is the preliminary workhorse for the confirmation of ingested foreign bodies, computed tomography owing to its volumetric data acquisition helps in exact localization of migrated foreign bodies and should precede any therapeutic intervention for retrieval of migrated foreign bodies.

Unusual case of mobile phone simulation SIM card’s outer case ingestion: wedged at laryngeal surface of epiglottis

<div class="page" title="Page 2"><div class="layoutArea"><div class="column"><p class="abstract">Accidental ingestion of foreign bodies in the pediatric population is usually small pieces from toys or other household objects and subsequent emergency department attendance is a common occurrence. Here we describe an unusual case of accidental swallowing where the foreign body is outer case of mobile phone simulation (SIM) card.</p></div></div></div>

Ingestion of Bell Clappers by a Shaman in Jumla, Nepal: A Case Report

Accidental foreign body ingestion is a common problem encountered in Emergency. Deliberate foreign body ingestion may result due to an act of insanity or an act of daring. A shaman locally known as Dhami was brought to Emergency with the history of ingestion of bell clappers. He denied the history of psychiatric illness or substance abuse. On physical examination, there were signs of peritonitis. Laparotomy was done to remove the foreign bodies. Post-operative period was uneventful. Apart from the surgical intervention, psychological counselling was given to him. This is a rare interesting case due to the fact that the 15 cm long foreign bodies passing all the way through without significant injury and finally causing obstruction in ileocecal junction and perforation in the distal ileum. Keywords: foreign bodies; Nepal; shaman.

Plastic foreign body appearing as radiopaque in a child: An interesting case

Accidental and unnoticed ingestion of foreign bodies (FBs) is not very uncommon. Most of such FBs pass through the gastrointestinal tract uneventfully and only on rare instances cause obstruction or perforation. We present here a case of unnoticed ingested plastic FB in an 11-month-old male child. The baby was presented to us with the complaint of acute intestinal obstruction. The plastic FB appeared as a radiopaque ring in the plain erect abdominal X-ray. The patient was managed by only sodium phosphate enema, which expelled the FB out through the anus.

Pyogenic Liver Abscess Secondary to Bowel Perforation by Ingested Fish Bone

Accidental ingestion of foreign bodies is a common clinical occurrence in medical practice, but hepatic abscess caused by said ingested foreign bodies is rather uncommon. Pre-operative diagnosis is difficult due to lack of patient awareness of the foreign body as well as non-specific symptoms and imaging findings. We hereby report a rare case of a 68-year-old African male who was admitted with fever and abdominal pain. Further investigation revealed a pyogenic liver abscess caused by an ingested fish bone penetrating the second part of the duodenum, without resolution despite initial antibiotic therapy. Final diagnosis and treatment included a combined endoscopic and surgical approach to remove the fish bone and repair the duodenal perforation along with CT-guided drainage of the abscess by interventional radiology.

Case Report on Esophageal Coin Management at District Hospital

Accidental foreign body ingestion is commonly encountered in the pediatric population, with a peak incidence between the ages of six months and three years. Since the act may go unnoticed, the child may present late. Here, we report a case of an 11 year old boy who present at Lamjung District Hospital after 24 hours of ingestions of two rupee Indian coin. To the best of our knowledge this is the first time we describe a case report on coin removal at district hospital of Nepal. J-GMC-N | Volume 11 | Issue 01 | January-June 2018, Page: 58-60

Transmesocolic double gastro-enteric fistulas due to ingestion of 28 magnets

Abstract Introduction Accidental ingestion of magnetic foreign bodies has become more common due to increased availability of objects and toys with magnetic elements. The majority of them traverse the gastrointestinal system spontaneously without complication. However, ingestion of multiple magnets may require surgical resolution. Magnet ingestion usually does not cause serious complications, but in case of multiple magnet ingestion or ingestion of magnet and a metal object, it could cause intestinal obstruction, fistula formation or even perforation. Case report We report case of a transmesocolic double gastro-enteric fistula formation following ingestion of 28 small magnets in a 17 months old boy. No history of foreign body ingestion could be obtained from parents therefore the patient was treated conservatively in a pediatric clinic for vomiting, dehydration, upper respiratory tract infection and suspicion of upper digestive tract bleeding. After 48 h he was sent in our clinic for surgical evaluation. Intraoperatively double transmesocolic gastro-enteric fistula was found. After separation of de gastric and enteral walls, resection of gastric wall and intestinal segment containing the two perforations was performed, followed by gastric suture in two layers and entero-enteric anastomosis. A total of 28 magnets were removed from the stomach and small intestine. Conclusion Single magnet ingestion is treated as non-magnetic foreign body. Multiple magnet ingestion should be closely monitored and surgical approach could be the best option to prevent or to cure its complications.

Accidental ingestion of foreign body in dental practice and its management

Foreign body aspiration or ingestion can be a potential complication or a life-threatening emergency situation. During routine dental treatment, the handling of dental objects requires particular care, especially with dental bridges and files. Precautionary measures have to be taken to avoid such situation. A dentist must be able to manage emergency situations in which accidental swallowing of dental instruments and materials occur. This article reviews the signs and symptoms, management, complications, and precautions of aspiration or ingestion of foreign bodies.

Small Bowel Perforation due to Ingested Foreign body

Small bowel perforation due to ingested foreign body is a rare but potentially life-threatening event. We present here 4 cases of small intestinal perforation caused by accidental ingestion of foreign bodies, from a total of 1,100 surgical procedures in one unit over a one-year period (September 2016 -August 2017). All 4 cases occurred in elderly patients who were using an artificial denture. The clinical appearance was that of acute abdomen, and in one case there had been formation of an enterocutaneous fistula a long time after the foreign body was swallowed. Typically, preoperative abdominal computed tomography (CT) showed the possible presence of a foreign body, which was confirmed intraoperatively. All 4 patients underwent surgery. Removal of the foreign body was performed, followed by primary intestinal closure or small bowel resection with a side-to-side anastomosis. Three of the 4 patients had an uneventful postoperative course, but one died on the 10th postoperative day, due to a severe postoperative pulmonary infection. Old age and artificial denture use appear to be strong risk factors, and the time and location of the perforation, and the presence of co-morbidities are prognostic factors for a successful surgical outcome. The choice of the type of surgery is individualized. A high level of clinical suspicion and meticulous investigation of the entire small intestine are required to ensure the correct diagnosis and early intervention for a successful outcome.

Abdominal Abscess due to Perforation of the Terminal Ieum Caused by a Fish Bone Treated by the Conservative Treatment Using Antibiotics

Accidental ingestion of the foreign bodies rarely develops the perforation of gastrointestinal tract, and the perforation of gastrointestinal tract can lead to severe complications such as abscess, enteric fistula, or intestinal obstruction, and peritonitis. As the standard management for foreign body-induced bowel perforation, surgery is commonly selected. We experienced a patient whose abdominal abscess is due to perforation of the terminal ileum by a fish bone. Streptococcus intermedius was isolated from abdominal abscess. An absence of fistula between intestinal tract and abscess and a remarkable improvement of laboratory data and symptoms by using antibiotics made us select the conservative treatment. In conclusion, we succeeded to treat conservatively abdominal abscess due to perforation by a fish bone by using appropriately selected antibiotics. J Med Cases. 2017;8(11):361-364 doi: https://doi.org/10.14740/jmc2930e

Migrated prawn tail presenting as neck swelling

Accidental ingestion of food-based foreign body such as fish bones and meat boluses are common among adults. Cases of migrated foreign bodies particularly the sharp-edged ones are also frequently encountered. The presentations of migrated foreign bodies in the neck can initially be asymptomatic and subsequently patients will come with complaint of foreign body or sharp pricking sensation on swallowing, odynophagia, fever or neck swelling. We report a case of a 61-year-old Chinese gentleman who presented with painful left neck swelling with history of eating prawn including its tail 2months prior to presentation. He was symptoms free after eating few boluses of rice since then. With positive findings on imaging studies, the neck lesion was successfully excised under local anesthesia. It contained a migrated intact prawn tail. In conclusion, accidental foreign body ingestion is not uncommon among adults. It is very important to elicit history of foreign body ingestion even in a patient presenting with neck swelling. Besides, oral and neck examination, other investigation modalities such as plain neck radiograph, ultrasonography or computed tomography scan can confirm the diagnosis of migrating foreign bodies and appropriate treatment can be instituted.

Reporte de un caso: perforación intestinal por cuerpo extraño

Accidental ingestion of foreign bodies in childhood is a common event that rarely requires interventional management and presents very few complications involving surgical treatment. We present a clinical case of a 10 month old infant, without abdominal manifestations, in whom it was incidentally found a foreign radiopaque body of 7 cm in length in the abdomen, compatible with a screw. It was not possible to extract it by endoscopy. Therefore, it was necessary to perform surgery and a perforation of the second and third portion of the duodenum was encountered.

Concomitant Crown and Piece of Tray Ingestion: A Case Report

The ingestion of a foreign body is a complication often seen in the hospital emergency rooms. The dental university hospital, where instruments and products are manipulated in the mouth, is an environment of risk. Previously, accidental foreign body ingestion during a routine dental procedure was reported by different groups. However, ingestion of multiple foreign bodies during a routine dental impression procedure is uncommon. Here, we describe a clinical case of accidental ingestion of concomitant crown and piece of tray. Some clinical implications are discussed, mainly emphasizing the care needed to prevent such an accident. J Med Cases. 2016;7(11):478-479 doi: http://dx.doi.org/10.14740/jmc2654w

FISH BONE PERFORATION OF SMALL BOWEL MIMICKING ACUTE APPENDICITIS

Accidental ingestion of foreign bodies is a commonly encountered event in clinical practice. However, small bowel perforation due to a fish bone is a rare phenomenon. Often, the exact diagnosis is missed preoperatively and is revealed only at laparotomy. Delay in diagnosis and treatment can be associated with significant morbidity and mortality. We report a case of 54- year male who presented with right lower quadrant pain with nausea and vomiting. Clinically, Acute appendicitis was diagnosed. Computerized tomography (CT) of the abdomen confirmed pockets of free air in the right lower quadrant with fat streaking suggestive of perforated ileum. On exploratory laparotomy, the ileal perforation was confirmed secondary to a fish bone. Although rare, foreign body perforation of the small bowel should be entertained in the differential diagnosis in certain groups of patients presenting with acute abdomen.

Accidental Foreign Body Ingestion Resulting in Detection of an Asymptomatic Colorectal Carcinoma

Foreign body ingestion is a fairly common clinical problem. The clinical course and resultant management is typically uncomplicated and will usually be predicted from the characteristics of the foreign body itself. However, an abnormal gastrointestinal tract segment can result in a complicated outcome. This article demonstrates such an example when an ingested foreign body that should have passed uneventfully, instead caused colonic obstruction by obturating a previously asymptomatic colon carcinoma. A 70 year old gentleman presented to the emergency department with onset of abdominal pain a few days following accidental ingestion of his dental crown. An initial plain abdominal radiograph followed immediately by a contrast enhanced abdominal MDCT showed an intraluminal metallic density foreign body, compatible with the ingested crown, causing obstruction at the splenic flexure lodging at a 3cm focal “apple core” lesion. Rapid decompression via colonic stent was then facilitated. Acute colonic obstruction due to accidental ingestion of a foreign body is rare. Plain film radiography may suffice for imaging of the uncomplicated foreign body ingestion. However, CT scanning, with the added technical development of 3D reconstruction capability can provide critical information in certain circumstances.

Concomitant Crown and Piece of Tray Ingestion: A Case Report

The ingestion of a foreign body is a complication often seen in the hospital emergency rooms. The dental university hospital, where instruments and products are manipulated in the mouth, is an environment of risk. Previously, accidental foreign body ingestion during a routine dental procedure was reported by different groups. However, ingestion of multiple foreign bodies during a routine dental impression procedure is uncommon. Here, we describe a clinical case of accidental ingestion of concomitant crown and piece of tray. Some clinical implications are discussed, mainly emphasizing the care needed to prevent such an accident. J Med Cases. 2016;7(11):478-479 doi: http://dx.doi.org/10.14740/jmc2654w

The Financial Burden and Health Care Utilization Related to Intentional Versus Unintentional Foreign Body Ingestion in a University Hospital: A Pilot Study

Introduction: Foreign body ingestion is a common problem faced by gastroenterologists. Previous literature has focused on accidental foreign body ingestion, primarily in the form of esophageal food impactions. Recently, the cost associated with intentional foreign body ingestion has been recognized as a significant problem. There are no studies assessing the financial impact of intentional foreign body ingestion compared to accidental ingestion. This study assesses the total hospital-related costs of intentional foreign body ingestion compared with unintentional ingestion. Methods: Retrospective review comparing the demographics, hospital length of stay (LOS), and overall cost for episodes of intentional ingestion of foreign bodies (IFB) compared to unintentional foreign body ingestions and esophageal food impactions (UFI) at the University of Arizona Medical Center. Hospital billing data from 2006-2012 generated from relevant ICD-9 codes was utilized to identify potential cases of foreign body ingestion. Due to initial availability of the data, we analyzed cases from 2010-2011 and identified appropriate cases from a detailed review of hospital charts and electronic medical records. Total cost based on emergency room, procedural, and inpatient costs were calculated. Total hospital length of stay, concurrent medical or psychiatric issues, endoscopic findings, and documented reason for ingestion were also assessed. Results: From Jan 2010-Dec 2011, 20 cases, consisting of 13 patients met criteria for IFB, and 29 cases consisting of 27 patients, met criteria for UFI. Two patients had 3 intentional foreign body ingestions, and 4 patients had two episodes of IFB. Two patients had a second episode of UFI. 75% of the IFB cases (9 patients) were reported suicidal attempts and 10 of the 13 patients with intentional foreign body ingestions had a psychiatric disorder. 70.6% of IFB cases required hospitalization compared to 11.1% UFI cases. Average LOS was 2.5 days for IFB compared to 0.78 days for UFI. The average total cost of medical care for IFB was $208,668.95 compared to $11349.94 for UFI (p=0.03350) (see table 1). Conclusion: In this study, the cost associated with IFB were significantly higher than for UFI. Patients with IFB also had higher rates of hospitalization, longer average LOS, more repeat episodes, and were more likely to have psychiatric disorders compared to UFI. To decrease the costs associated with IFB, additional resources for prevention including psychiatric care may be beneficial.Table 1

Small bowel perforation due to fish bone: A case report

Accidental ingestion of foreign bodies are a common condition in clinical practice. However, small bowel perforation which dues to ingestion foreign bodies has been rarely seen. In this article, we report a case of small bowel perforation which dues to ingestion foreign body. A 80-year-old female patient, presenting with complaints of acute abdomen, was admitted to the emergency department. She denied abdominal pain, nausea and vomiting. The patient had tenderness and defense on the right lower quadrant. Contrast enhanced abdominal computed tomography has been used on the patient's diagnosis. This revealed small bowel perforation due to the ingestion of foreign body. The patient was operated emergency. A microperforation due to fish bone was detected on the terminal ileum. The patient underwent debridement and primary repair. The patient was discharged postoperative 7th day without problem. Bowel perforation due to the ingestion of foreign bodies should be considered in the differential diagnosis of acute abdomen.