|
1
|
Mokbul MI, Roy S, Roy AN, Shrestha A, Nawys M. Not your typical abdominal pain: Case report of a fisherman presenting to the trauma & emergency surgery department with intestinal perforation due to an eel fish. Int J Surg Case Rep 2024; 124:110401. [PMID: 39366115 PMCID: PMC11483642 DOI: 10.1016/j.ijscr.2024.110401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 09/30/2024] [Accepted: 09/30/2024] [Indexed: 10/06/2024] Open
Abstract
BACKGROUND Traumatic intestinal perforation by foreign bodies is rare, with cases involving live fish being exceedingly uncommon, with only one reported case to date. We present a unique case of a 55-year-old fisherman who presented to the Emergency Department with traumatic intestinal perforation due to an eel fish accidentally entering his rectum. Despite initial reluctance to seek medical attention, prompt intervention was crucial to addressing peritonitis. CASE PRESENTATION The patient presented with severe abdominal pain and signs of peritonitis. X-ray findings confirmed pneumoperitoneum. Urgent laparotomy revealed a live eel fish and a 5 cm sigmoid colon perforation, necessitating a sigmoid colostomy. DISCUSSION Early recognition of traumatic intestinal perforation is vital for prompt management. Diagnosis can be challenging, emphasizing the need for thorough history-taking and imaging. Surgical intervention aims to repair the intestinal perforation, prevent complications and promote healing. CONCLUSION This case highlights the importance of considering unusual causes of abdominal pain, particularly in relevant occupational history. Prompt surgical intervention is crucial for favorable clinical outcomes.
Collapse
Affiliation(s)
| | - Soumik Roy
- Dhaka Medical College, Dhaka, Bangladesh
| | | | | | - Mostafa Nawys
- Department of Surgery, Sheikh Hasina Medical College Tangail, Tangail, Bangladesh
| |
Collapse
|
|
2
|
Ehrsam JP, Meier Adamenko O, Schlumpf RB, Schöb OM. Foreign Glass Bodies in Pleura and Pancreas: Systematic Review for Entry Hypotheses and Treatment Options in an Unresolved Case. Surg Laparosc Endosc Percutan Tech 2024; 34:206-221. [PMID: 38450728 PMCID: PMC10986785 DOI: 10.1097/sle.0000000000001275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 12/19/2023] [Indexed: 03/08/2024]
Abstract
BACKGROUND Foreign bodies within the pleura and pancreas are infrequent, and the approaches to their treatment still a subject of debate. There is limited knowledge particularly regarding glass foreign bodies. METHODS We present a case involving large glass splinters in the pleura and pancreas, with an unknown entry point. In addition, a systematic review was conducted to explore entry hypotheses and management options. RESULTS In addition to our case, our review uncovered eight incidents of intrapleural glass, and another eight cases of glass in other intrathoracic areas. The fragments entered the body through impalement (81%), migrated through the diaphragm after impalement (6%), or caused transesophageal perforation (19%) following ingestion. Eight instances of glass inside the abdominal cavity were documented, with seven resulting from impalement injuries and one from transintestinal migration. There were no recorded instances of glass being discovered within the pancreas. Among the 41 nonglass intrapancreatic foreign bodies found, sewing needles (34%) and fish bones (46%) were the most common; following ingestion, they had migrated through either a transgastric or transduodenal perforation. In all these cases, how the foreign bodies were introduced was often poorly recalled by the patient. Many nonglass foreign bodies tend to become encapsulated by fibrous tissue, rendering them inert, though this is less common with glass. Glass has been reported to migrate through various tissues and cavities, sometimes with a significant delay spanning even decades. There are cases of intrapleural migration of glass causing hemothorax, pneumothorax, and heart and major blood vessels injury. For intrapleural glass fragment management, thoracoscopy proved to be effective in 5 reported cases, in addition to our patient. Most intrapancreatic nonglass foreign bodies tend to trigger pancreatitis and abscess formation, necessitating management ranging from laparoscopic procedures to subtotal pancreatectomy. There have been only four documented cases of intrapancreatic needles that remained asymptomatic with conservative management. There is no direct guidance from the existing literature regarding management of intrapancreatic glass foreign bodies. Consequently, our patient is under observation with regular follow-ups and has remained asymptomatic for the past 2 years. CONCLUSIONS Glass foreign bodies in the pleura are rare, and our report of an intrapancreatic glass fragment is the first of its kind. Impalement is the most likely method of introduction. As glass has significant migration and an ensuing complication potential, preventive removal of intrapleural loose glass should be considered. However, intrapancreatic glass fragment management remains uncertain.
Collapse
|
|
3
|
Wu YJ, Chen YY, Hsieh YC. Unusual Pancreatic Abscess Secondary to Embedded Fish Bone: A Challenging Clinical Scenario. Diagnostics (Basel) 2022; 12:diagnostics12122999. [PMID: 36553006 PMCID: PMC9777479 DOI: 10.3390/diagnostics12122999] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/16/2022] [Accepted: 11/30/2022] [Indexed: 12/02/2022] Open
Abstract
The incidental ingestion of fish bone is common, and the ingested fish bone mostly exits the gastrointestinal tract spontaneously. However, severe complications such as perforation in the digestive tract and abscess formation after a period of time may occasionally occur. Fewer than 10 cases of a migrated fish bone penetrating into the pancreas have been reported in the literature, and the development of a subsequent pancreatic abscess is extremely rare. We present one such rare case of pancreatic abscess formation in a middle-aged woman due to fish bone penetration through the gastric wall into the pancreas 2 months after ingestion and missed on endoscopy initially. Further imaging revealed that the fish bone was partially embedded in the pancreatic head surrounded with abscesses and was smoothly removed through laparoscopy.
Collapse
Affiliation(s)
- Yu-Jie Wu
- Department of Radiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan
| | - Ying-Ying Chen
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei 116079, Taiwan
| | - Yi-Chien Hsieh
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei 116079, Taiwan
- Correspondence: ; Tel.: +886-229-307-930 (ext. 1300); Fax: +886-229-316-809
| |
Collapse
|
|
4
|
Grayson N, Shanti H, Patel AG. OUP accepted manuscript. J Surg Case Rep 2022; 2022:rjac026. [PMID: 35178243 PMCID: PMC8846943 DOI: 10.1093/jscr/rjac026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/15/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Niamh Grayson
- Institute of Liver Studies, Kings College Hospital, London, UK
| | - Hiba Shanti
- Institute of Liver Studies, Kings College Hospital, London, UK
| | - Ameet G Patel
- Institute of Liver Studies, Kings College Hospital, London, UK
- Correspondence address. King’s College Hospital, Denmark Hill, London SE5 9RS, UK. Tel: +44-7740-705060;
| |
Collapse
|
|
5
|
Abstract
Ingestion of foreign bodies is common within the pediatric population; in adults, it occurs more commonly in those with a psychiatric background. Diagnosis of such cases can be readily made based on plain abdominal X-rays. As reported, many foreign bodies pass through the gastrointestinal tract without complications, obstruction, bleeding, and perforation. The ultimate decision of the best management approach for such cases should be made based on the available expertise as well as the patient's specific factors. Observation, endoscopic removal, and surgical intervention are all acceptable approaches in cases of metal foreign body ingestion. We report a case of a 29-year-old male patient brought to the emergency department following ingestion of multiple sharp nails. He underwent surgical exploration, which resulted in the retrieval of 73 metallic nails.
Collapse
Affiliation(s)
- Ahmed M AlMuhsin
- Department of General Surgery, Security Forces Hospital, Dammam, SAU
| | - Fatima Alsalman
- Department of General Surgery, Security Forces Hospital, Dammam, SAU
| | - Ahmad Bubshait
- Department of General Surgery, Security Forces Hospital, Dammam, SAU
| | - Rami O Abu Hajar
- Department of General Surgery, Security Forces Hospital, Dammam, SAU
| |
Collapse
|
|
6
|
Wang Z, Du Z, Zhou X, Chen T, Li C. Misdiagnosis of peripheral abscess caused by duodenal foreign body: a case report and literature review. BMC Gastroenterol 2020; 20:236. [PMID: 32703254 PMCID: PMC7376966 DOI: 10.1186/s12876-020-01335-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/05/2020] [Indexed: 12/27/2022] Open
Abstract
Background The induction of chronic inflammation, perforation, and abscess by foreign bodies (FBs) in adults is uncommon. We present a delayed diagnosis case for a patient who had a fishbone stuck in the duodenal bulb, resulting in chronic abdominal pain for nearly 3 months. We present the diagnosis and treatment procedures for chronic patients, which differ from those for acute and emergency FB ingestion, and also summarize the characteristics of such patients through a systematic literature review. Case presentation A 68-year-old woman was brought to our hospital with repeated right upper abdominal pain lasting for 3 months and aggravation for 9 h. Computed tomography (CT) showed a streaky high-density shadow (approximately 3 cm in length) on the posterior wall of the gastric antrum extending outside the wall. Endoscopic ultrasonography showed hyperechoic space with a cross-section of approximately 0.1 × 0.1 cm in the deep submucosal layer of the local stomach, accompanied by an acoustic shadow in the rear. The possibility of a fishbone as well as perforation was considered and the object was removed using FB forceps. Fasting as well as acid inhibition and anti-infection medication were prescribed for the patient. She eventually recovered and was discharged from the hospital. Conclusion Endoscopic intervention can be recommended as the first option for patients with gastrointestinal FBs.
Collapse
Affiliation(s)
- Zhihui Wang
- Department of Gastroenterology, Jianyang People's Hospital, No. 180 Yiyuan Road, Jianyang City, 641400, China
| | - Zhiqiang Du
- Department of Gastroenterology, Jianyang People's Hospital, No. 180 Yiyuan Road, Jianyang City, 641400, China.
| | - Xiangrong Zhou
- Department of Gastroenterology, Jianyang People's Hospital, No. 180 Yiyuan Road, Jianyang City, 641400, China
| | - Tianming Chen
- Department of Gastroenterology, Jianyang People's Hospital, No. 180 Yiyuan Road, Jianyang City, 641400, China
| | - Chunyan Li
- Department of Gastroenterology, Jianyang People's Hospital, No. 180 Yiyuan Road, Jianyang City, 641400, China
| |
Collapse
|
|
7
|
Retained Foreign Body Causing a Liver Abscess. Case Rep Emerg Med 2020; 2019:4259646. [PMID: 31934467 PMCID: PMC6942747 DOI: 10.1155/2019/4259646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/03/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction A liver abscess caused by fishbone ingestion is extremely rare in the Emergency Department. Case Report We report a case of a middle-aged female who presented to the Emergency Department with nonspecific symptoms. Computed tomography showed a liver abscess that had formed secondary to a fishbone. The patient was treated conservatively initially and subsequently with percutaneous drainage and finally with open drainage. Her condition improved and she was discharged from the hospital with the foreign body still in-situ. Conclusion This case is one of six cases in literature where the patient has been discharged successfully from the hospital with a retained fishbone. It also demonstrates the difficulty of diagnosing a foreign body causing a liver abscess and the multiple treatment modalities used to treat a liver abscess caused by fishbone.
Collapse
|
|
8
|
Goyal P, Gupta S, Sapire J. Bone Causing Abdominal Groans. J Emerg Med 2019; 57:e95-e97. [PMID: 31378443 DOI: 10.1016/j.jemermed.2019.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/05/2019] [Accepted: 06/15/2019] [Indexed: 06/10/2023]
Abstract
Gastrointestinal complications secondary to fish bone ingestion are rare, however important to recognize in timely manner to prevent morbidity and mortality. Diagnosis is often challenging in setting of non-specific and variable symptoms and lack of history of fish bone ingestion. Diagnostic imaging particularly computed tomography is crucial for diagnosis. However, emphasis should be given on identifying underlying cause of abdominal complications because fish bone is often missed unless specifically looked for. Identification of fish bone is essential for extraction of the inciting nidus. Emergency physician should be aware of this entity to identify it and triage the patients in timely manner. We describe here cases of sub-capsular liver abscess and acute cholecystitis caused by fish bone ingestion. The fish bone as a cause of these complication was initially missed in emergency.
Collapse
Affiliation(s)
- Pradeep Goyal
- Department of Radiology, St. Vincent's Medical Center, Bridgeport, Connecticut; The Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Connecticut
| | - Sonali Gupta
- The Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Connecticut; Department of Medicine, St. Vincent's Medical Center, Bridgeport, Connecticut
| | - Joshua Sapire
- Department of Radiology, St. Vincent's Medical Center, Bridgeport, Connecticut; The Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Connecticut
| |
Collapse
|
|
9
|
Chen J, Wang C, Zhuo J, Wen X, Ling Q, Liu Z, Guo H, Xu X, Zheng S. Laparoscopic management of enterohepatic migrated fish bone mimicking liver neoplasm: A case report and literature review. Medicine (Baltimore) 2019; 98:e14705. [PMID: 30882633 PMCID: PMC6426515 DOI: 10.1097/md.0000000000014705] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 01/29/2019] [Accepted: 02/05/2019] [Indexed: 12/12/2022] Open
Abstract
RATIONALE Accidental ingestion of a foreign body is common in daily life. But the hepatic migration of perforated foreign body is rather rare. PATIENT CONCERNS A 37-year-old man presented with a history of vague epigastric discomfort for about 2 months. DIAGNOSIS A diagnosis of the foreign body induced hepatic inflammatory mass was made based on abdominal computed tomographic scan and upper gastrointestinal endoscopy. INTERVENTIONS The patient underwent laparoscopic laparotomy. During the operation, inflammatory signs were seen in the lesser omentum and segment 3 of liver. B- Ultrasound guided excision of the mass (in segment 3) was performed. Dissecting the specimen revealed a fish bone measuring 1.7 cm in length. OUTCOMES The patient recovered uneventfully and was discharged on day 5 after surgery. LESSONS This study shows the usefulness of endoscopy for final diagnosis and treatment in foreign body ingestion. Early diagnosis and decisive treatment in time are lifesaving for patients with this potentially lethal condition.
Collapse
Affiliation(s)
- Jun Chen
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Key Lab of Combined Multi-Organ Transplantation, Ministry of Public Health, First Affiliated Hospital, Zhejiang University School of Medicine, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | | | | | | | | | | | | | | | | |
Collapse
|
|
10
|
Li F, Zhou X, Wang B, Guo L, Ma Y, Wang D, Wang L, Zhang L, Wang H, Zhang L, Tian M, Tao M, Xiu D, Fu W. Intestinal Perforation Secondary to Pits of Jujube Ingestion: A Single-Center Experience with 18 Cases. World J Surg 2019; 43:1198-1206. [PMID: 30659341 DOI: 10.1007/s00268-018-04902-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Ingestion of jujube pits is a common clinical problem, which can be difficult to diagnose and life-threatening if accompanied with intestinal perforation and peritonitis. In this study, 18 cases of intestinal perforation caused by ingestion of jujube pits were reviewed and summarized to discuss the clinical characteristics, diagnosis and treatments. METHODS From 2012 to 2018, a total of 18 patients diagnosed as intestinal perforation due to ingested pits of jujube in our center were retrospectively reviewed and the manifestations, laboratory tests, imaging examinations and treatment strategies were summarized. RESULTS The patients comprised of 11 males and 7 females with an average age of 63.5 years. The main clinical manifestation was abdominal pain. Twelve patients (67%) presented to the emergency department with signs of localized peritonitis. CT imaging revealed positive findings in 17 (94%) patients. Conservative treatments were attempted in 3 patients, and the other 15 patients received emergency surgical exploration, where 7 patients had more than one perforation identified during surgery. Five patients were admitted in the surgical intensive care unit after surgery. The average length of stay of all 18 patients was 9.8 days (range 5-24 days). CONCLUSION Ingestion of jujube pits is a common clinical problem and potentially leads to intestinal perforation and peritonitis. CT imaging is the first imaging modality of choice. Patients with milder symptoms might be managed with cautious conservative treatment, and patients with more than one perforation can be identified during surgery.
Collapse
Affiliation(s)
- Fei Li
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Xin Zhou
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Bingyan Wang
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Lei Guo
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Yanpeng Ma
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Dechen Wang
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Liang Wang
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Li Zhang
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Hangyan Wang
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Lingfu Zhang
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Maolin Tian
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Ming Tao
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Dianrong Xiu
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Wei Fu
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China.
| |
Collapse
|
|
11
|
Fleres F, Ieni A, Saladino E, Speciale G, Aspromonte M, Cannaò A, Macrì A. Rectal perforation by inadvertent ingestion of a blister pack: A case report and review of literature. World J Clin Cases 2018; 6:384-392. [PMID: 30283801 PMCID: PMC6163132 DOI: 10.12998/wjcc.v6.i10.384] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/26/2018] [Accepted: 08/26/2018] [Indexed: 02/05/2023] Open
Abstract
The accidental ingestion of a foreign body (FB) is a relatively common condition. In the present study, we report a peculiar case of rectal perforation, the first to our knowledge, caused by the inadvertent ingestion of a blister pill pack. The aim of this report is to illustrate the difficulties of the case from a diagnostic and therapeutic viewpoint as well as its unusual presentation. A 75-year-old woman, mentally impaired, arrived at our emergency department in critical condition. The computed tomography scan revealed a substantial abdominopelvic peritoneal effusion and free perigastric air. The patient was therefore submitted to an urgent exploratory laparotomy; a 2-cm long, full-thickness lesion was identified in the anterior distal part of the intraperitoneal rectum. Hence, we performed a Hartmann's procedure. Because of her critical condition, the patient was eventually transferred to the Intensive Care Unit, where she died after 10 d, showing no surgical complication. The ingestion of FBs is usually treated with observation or endoscopic removal. Less than 1% of FBs are likely to cause an intestinal perforation. The intestinal perforation resulting from the unintentional ingestion of an FB is often a difficult challenge when it comes to treatment, due to its late diagnosis and the patients' deteriorated clinical condition.
Collapse
Affiliation(s)
- Francesco Fleres
- Department of Human Pathology of the Adult and Evolutive Age “Gaetano Barresi”, Section of General Surgery, University of Messina, Messina 98125, Italy
| | - Antonio Ieni
- Department of Human Pathology of the Adult and Evolutive Age “Gaetano Barresi”, Section of Anatomic Pathology, University of Messina, Messina 98125, Italy
| | - Edoardo Saladino
- General and Oncologic Surgery Unit, Clinica Cappellani-GIOMI, Messina 98168, Italy
| | - Giuseppe Speciale
- Department of Human Pathology of the Adult and Evolutive Age “Gaetano Barresi”, Section of Anatomic Pathology, University of Messina, Messina 98125, Italy
| | - Michele Aspromonte
- Department of Human Pathology of the Adult and Evolutive Age “Gaetano Barresi”, Section of General Surgery, University of Messina, Messina 98125, Italy
| | - Antonio Cannaò
- Messina University Medical School Hospital, Messina 98125, Italy
| | - Antonio Macrì
- Peritoneal Surface Malignancy and Soft Tissue Sarcoma Program, Messina University Medical School Hospital, Messina 98125, Italy
| |
Collapse
|
|
12
|
Liu S, Li Q, Li Y, Lv Y, Niu J, Xu Q, Zhao J, Chen Y, Wang D, Bai R. Ileocecal junction perforation caused by a sewing needle in incarcerated inguinal hernia: An unusual case report. Medicine (Baltimore) 2018; 97:e10787. [PMID: 29851786 PMCID: PMC6393046 DOI: 10.1097/md.0000000000010787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION This case study is concerning the meticulous observation of the moving process and track of 2 ingested needles using interval x-ray radiography, trying to localize the foreign bodies and reduce unnecessary exploration of digestive tract. CASE PRESENTATION An unusual case of a 1-year, 9-month-old female baby, with incarcerated hernia perforation caused by sewing needles with sharp ends, was reported herein. The patient had swallowed 2 sewing needles. One needle was excreted uneventfully after 8 days. On the contrary, the other needle stabbed the ileocecal junction wall into the right side of inguinal hernia sac after 9 days, and the patient received successful operation management. Interval x-ray confirmed that 1 needle-like foreign body moving down in 8 days until excretion along with feces. However, the other pierced into the incarcerated hernia. Preoperative x-ray radiography successfully monitored the moving process and tract of the sewing needles. Considering the penetrating-migrating nature of the foreign bodies, once the sharp-pointed objects were located, they should be removed as the mortality and risk of related complications may be increased. CONCLUSION Interval x-ray radiography represents a meticulous preoperative monitoring method of the moving process and tract of needle-like foreign bodies. Interval x-ray with real-time images accurately detecting the moving foreign bodies could be help to reduce the unnecessary exploration of digestive tract and subsequently prevent possible complications. Based on the basic findings from the interval x-ray, treatment choices of endoscopic removal and surgical intervention may be attempted.
Collapse
Affiliation(s)
- Shiqi Liu
- Department of Pediatric Surgery, Northwest Women's and Children's Hospital, Xi’an, Shaanxi Province
| | - Qifeng Li
- Xinjiang Institute of Pediatrics, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, P.R. China
| | - Yumei Li
- The Interdisciplinary Centre for Security, Reliability and Trust (Sn T), University of Luxembourg, Luxembourg, Luxembourg
| | - Yi Lv
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shanxi Province
| | - Jianhua Niu
- Third Department of General Surgery, The First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, Xinjiang
| | - Quan Xu
- Department of Pediatric Surgery, Northwest Women's and Children's Hospital, Xi’an, Shaanxi Province
| | - Jingru Zhao
- Department of Pediatric Surgery, Northwest Women's and Children's Hospital, Xi’an, Shaanxi Province
| | - Yajun Chen
- Department of Basic Surgery, Beijing Children's Hospital, Capital Medical University, Beijing
| | - Dayong Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shanxi Province
| | - Ruimiao Bai
- Department of Neonatal Intensive Care Unit, Northwest Women's and Children's Hospital, Xi’an, Shaanxi Province, P.R. China
| |
Collapse
|
|
13
|
Dal F, Hatipoğlu E, Teksöz S, Ertem M. Foreign body: A sewing needle migrating from the gastrointestinal tract to pancreas. Turk J Surg 2018; 34:256-258. [PMID: 30302435 DOI: 10.5152/turkjsurg.2017.3391] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 12/03/2015] [Indexed: 12/26/2022]
Abstract
Of all ingested foreign bodies, 2.4% comprise of sewing needles. Through perforation of gastrointestinal tract, which occurs in 1% of cases, they can migrate into the liver and pancreas. Foreign bodies in pancreas should be considered in the differential diagnosis of chronic abdominal pain. Computed tomography scans provide valuable information for the localization of the lesion, which guide the surgeon during the operation. Secondary to foreign bodies that migrate to the pancreas, complications with high mortality such as pancreatitis, pseudoaneurysm, and pancreas abscess can be seen. Thus, for this patient group, diagnostic laparoscopy is recommended, considering its advantages of decreased postoperative pain, decreased wound infection, and faster recovery time. Here we present a case of a 23-year-old female patient, from whom an ingested needle that migrated from the back wall of the stomach to the pancreas was extracted by laparoscopic surgery.
Collapse
Affiliation(s)
- Fatih Dal
- Department of General Surgery, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Engin Hatipoğlu
- Department of General Surgery, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Serkan Teksöz
- Department of General Surgery, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Metin Ertem
- Department of General Surgery, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| |
Collapse
|
|
14
|
Tan CH, Chang SYH, Cheah YL. Laparoscopic Removal of Intrahepatic Foreign Body: A Novel Technique for Management of an Unusual Cause of Liver Abscess--Fish Bone Migration. J Laparoendosc Adv Surg Tech A 2016; 26:47-50. [PMID: 26779724 DOI: 10.1089/lap.2015.0487] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Fish bone migration from the gastrointestinal tract into the liver is an unusual cause of liver abscess. MATERIALS AND METHODS We describe successful laparoscopic removal of intrahepatic fish bones in 2 patients who presented with liver abscesses. Both patients were admitted to our institution with a 2-week history of right upper quadrant pain, fever, chills, and rigors. Radiological imaging revealed the presence of a linear calcified foreign body within a hepatic abscess in the left lateral section of the liver. These findings were suggestive of infection secondary to migration of fish bone from the stomach to the liver. RESULTS Both patients underwent percutaneous drainage of liver abscesses with control of sepsis, followed by laparoscopic removal of intrahepatic fish bones. Localization of the fish bones was facilitated by intraoperative ultrasonographic examination of the liver. Postoperative recovery was fast and uneventful. CONCLUSIONS This is the first report of two consecutive cases of liver abscess caused by fish bone migration where our patients were successfully treated by percutaneous drainage of the abscess followed by laparoscopic removal of intrahepatic fish bone.
Collapse
Affiliation(s)
- Chun Hai Tan
- 1 Department of General Surgery, Khoo Teck Puat Hospital , Singapore
| | | | - Yee Lee Cheah
- 3 Consultant, Asian American Liver Centre , Singapore
| |
Collapse
|
|
15
|
Nasri B, Yuu K, Tada M. A case report of successful removal of multiples sewing needles in the gastrointestinal tract and pancreas using intraoperative C-arm fluoroscopy. Int J Surg Case Rep 2016; 24:166-71. [PMID: 27266827 PMCID: PMC4909132 DOI: 10.1016/j.ijscr.2016.05.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 05/25/2016] [Indexed: 01/08/2023] Open
Abstract
Operative interventions are still necessary in 1% foreign bodies. Timely diagnosis can be difficult. Migration to the pancreas, or the anterior abdominal wall, is extremely rare. Preoperative CT scan locates the foreign bodies and the presence of theirs related complications. C-arm fluoroscopy is a cost effective intraoperative diagnostic modality which is easily applied. Background Most ingested foreign bodies pass uneventfully through the digestive tract without any major disturbances. Objectives We reports a rare case of successful localization and surgical removal of needles in the gastrointestinal tract using C-arm fluoroscopy intraoperatively. Case report A 46 year old female, a non-hospitalized psychiatric patient, presented with acute abdominal pain. Imaging showed 16 needles all over the digestive tract. C arm fluoroscopy was used to successfully localize and remove all of the needles intraoperatively. One needle was withdrawn from the pancreas manually without pancreatic resection. Discussion It is estimated that up to 10–20% cases require endoscopic removal and 1% cases with the presence of obstruction or perforation necessitate surgical interventions [1], [2], [3], [4] (Hsieh et al., 2005; Anderson and Dean, 2011; Cheng and Tam, 1999; Ricci et al., 2014). Migration to the pancreas extremely rare [5,6] (Toyonaga et al., 2001; Yasuda et al., 2010). Timely diagnosis can be difficult [7] (Tsui and Mossey, 1997). CT scan is a modality of choice to preoperatively locate the foreign body [8] (Takada et al., 2000). We herein successfully localized and removed 15 needles using C-arm fluoroscopy intraoperatively. It is extremely useful to accurately detect radiopaque foreign bodies. On the basic of findings on CT, treatment of choice such as endoscopic removal or surgical intervention may be attempted. Conclusions CT scan is a modality of choice to preoperatively locate the foreign body. Sharp-pointed objects should be removed even if the patient is asymptomatic as the increased mortality and the risk of related complications. Intraoperative C-arm fluoroscopy is a feasible, cost-effective modality with real-time image to accurately detect multiple radiopaque objects especially when they are disseminating throughout the digestive tract.
Collapse
Affiliation(s)
- Baongoc Nasri
- Department Of Surgery, Tokyo Metropolitan Matsuzawa Hospital, Setagayaku Kamikitazawa 2-1-1, Tokyo 156-0057, Japan.
| | - Ken Yuu
- Department Of Surgery, Tokyo Metropolitan Matsuzawa Hospital, Setagayaku Kamikitazawa 2-1-1, Tokyo 156-0057, Japan
| | - Masanori Tada
- Department Of Surgery, Tokyo Metropolitan Matsuzawa Hospital, Setagayaku Kamikitazawa 2-1-1, Tokyo 156-0057, Japan
| |
Collapse
|
|
16
|
Kuzmich S, Burke CJ, Harvey CJ, Kuzmich T, Andrews J, Reading N, Pathak S, Patel N. Perforation of gastrointestinal tract by poorly conspicuous ingested foreign bodies: radiological diagnosis. Br J Radiol 2015; 88:20150086. [PMID: 25827210 DOI: 10.1259/bjr.20150086] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Perforation of gastrointestinal (GI) tract by ingested bone fragments, toothpicks and dentures is rare but remains an important life-threatening condition, and the outcomes are poorer when the diagnosis is delayed. Invariably, clinical and radiographic diagnosis is difficult as most patients will have no recollection of ingesting a foreign body, whereas these subtle objects are often not visible on radiographs. In search for the diagnosis, CT is the modality of choice, but ultrasound imaging may be first requested in patients presenting with symptoms of acute appendicitis, cholecystitis, pyelonephritis or pelvic inflammatory disease when an ingested foreign body is not considered. Although ultrasound has limited value in depicting a foreign body, it can frequently uncover secondary signs of perforation. However, the rarity of this condition combined with non-specific clinical presentation and the propensity of these small perforating objects to be subtle makes establishing the correct diagnosis by the radiologist challenging. Therefore, understanding of the appearances of GI perforation seen on CT images or general abdominal ultrasound will aid the radiologist in the diagnosis of this important yet often unsuspected condition. This will lead to earlier diagnosis and surgical management. In this article, we illustrate the spectrum of CT, radiographic and ultrasound imaging features seen in GI perforation caused by swallowed bone fragments, toothpicks, cocktail sticks and dentures.
Collapse
Affiliation(s)
- S Kuzmich
- 1 Radiology Department, Whipps Cross University Hospital, London, UK
| | | | | | | | | | | | | | | |
Collapse
|
|
17
|
Zouros E, Oikonomou D, Theoharis G, Bantias C, Papadimitropoulos K. Perforation of the Cecum by a Toothpick: Report of a Case and Review of the Literature. J Emerg Med 2014; 47:e133-7. [DOI: 10.1016/j.jemermed.2014.06.065] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Revised: 05/28/2014] [Accepted: 06/30/2014] [Indexed: 12/17/2022]
|
|
18
|
Matrella F, Lhuaire M, Piardi T, Dokmak S, Bruno O, Maestraggi Q, Kianmanesh R, Sommacale D. Liver hilar abscesses secondary to gastrointestinal perforation by ingested fish bones: surgical management of two cases. Hepatobiliary Surg Nutr 2014; 3:156-62. [PMID: 25019078 DOI: 10.3978/j.issn.2304-3881.2014.04.01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 02/28/2014] [Indexed: 01/16/2023]
Abstract
Several hepatobiliary complications secondary to gastrointestinal perforation after ingestion of a fish bone have been described in the literature, the most common being liver abscess, which can be potentially fatal. Treatment involves removal of the foreign body if possible (endoscopically or surgically), drainage of the abscess (radiologically or surgically), and appropriate antibiotic therapy. To our knowledge, no cases of hepatic hilar abscesses secondary to gastrointestinal perforation by a fish bone have been described in the literature. We report surgical management of two cases of abscess localized in the hepatic hilum secondary to the ingestion of fish bones.
Collapse
Affiliation(s)
- Fulvio Matrella
- 1 Department of General, Plastic and Ambulatory Surgery, Hôpital Cochin Port-Royal, Assistance Publique des Hôpitaux de Paris, Paris, France ; 2 Department of General, Digestive and Endocrine Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France ; 3 Department of Hepato-biliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 4 Department of Radiology, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 5 Department of Internal Medicine, Infectious Diseases and Clinical Immunology, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France
| | - Martin Lhuaire
- 1 Department of General, Plastic and Ambulatory Surgery, Hôpital Cochin Port-Royal, Assistance Publique des Hôpitaux de Paris, Paris, France ; 2 Department of General, Digestive and Endocrine Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France ; 3 Department of Hepato-biliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 4 Department of Radiology, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 5 Department of Internal Medicine, Infectious Diseases and Clinical Immunology, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France
| | - Tullio Piardi
- 1 Department of General, Plastic and Ambulatory Surgery, Hôpital Cochin Port-Royal, Assistance Publique des Hôpitaux de Paris, Paris, France ; 2 Department of General, Digestive and Endocrine Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France ; 3 Department of Hepato-biliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 4 Department of Radiology, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 5 Department of Internal Medicine, Infectious Diseases and Clinical Immunology, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France
| | - Safi Dokmak
- 1 Department of General, Plastic and Ambulatory Surgery, Hôpital Cochin Port-Royal, Assistance Publique des Hôpitaux de Paris, Paris, France ; 2 Department of General, Digestive and Endocrine Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France ; 3 Department of Hepato-biliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 4 Department of Radiology, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 5 Department of Internal Medicine, Infectious Diseases and Clinical Immunology, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France
| | - Onorina Bruno
- 1 Department of General, Plastic and Ambulatory Surgery, Hôpital Cochin Port-Royal, Assistance Publique des Hôpitaux de Paris, Paris, France ; 2 Department of General, Digestive and Endocrine Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France ; 3 Department of Hepato-biliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 4 Department of Radiology, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 5 Department of Internal Medicine, Infectious Diseases and Clinical Immunology, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France
| | - Quentin Maestraggi
- 1 Department of General, Plastic and Ambulatory Surgery, Hôpital Cochin Port-Royal, Assistance Publique des Hôpitaux de Paris, Paris, France ; 2 Department of General, Digestive and Endocrine Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France ; 3 Department of Hepato-biliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 4 Department of Radiology, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 5 Department of Internal Medicine, Infectious Diseases and Clinical Immunology, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France
| | - Reza Kianmanesh
- 1 Department of General, Plastic and Ambulatory Surgery, Hôpital Cochin Port-Royal, Assistance Publique des Hôpitaux de Paris, Paris, France ; 2 Department of General, Digestive and Endocrine Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France ; 3 Department of Hepato-biliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 4 Department of Radiology, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 5 Department of Internal Medicine, Infectious Diseases and Clinical Immunology, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France
| | - Daniele Sommacale
- 1 Department of General, Plastic and Ambulatory Surgery, Hôpital Cochin Port-Royal, Assistance Publique des Hôpitaux de Paris, Paris, France ; 2 Department of General, Digestive and Endocrine Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France ; 3 Department of Hepato-biliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 4 Department of Radiology, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France ; 5 Department of Internal Medicine, Infectious Diseases and Clinical Immunology, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France
| |
Collapse
|
|
19
|
Chong LW, Sun CK, Wu CC, Sun CK. Successful treatment of liver abscess secondary to foreign body penetration of the alimentary tract: A case report and literature review. World J Gastroenterol 2014; 20:3703-3711. [PMID: 24707157 PMCID: PMC3974541 DOI: 10.3748/wjg.v20.i13.3703] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 12/24/2013] [Accepted: 01/20/2014] [Indexed: 02/07/2023] Open
Abstract
Hepatic abscess caused by foreign body penetration of the alimentary tract is rare. We report a case of gastric antrum penetration due to a toothpick complicated by liver abscess formation. A 41-year-old man was admitted to our hospital with the chief complaint of upper abdominal pain for 2 mo. Esophagogastroduodenoscopy performed at a local clinic revealed a toothpick penetrating the gastric antrum. Computed tomography (CT) of the abdomen at our hospital revealed a gastric foreign body embedded in the posterior wall of gastric antrum with regional phlegmon over the lesser sac and adhesion to the pancreatic body without notable vascular injury, and a hepatic abscess seven cm in diameter over the left liver lobe. Endoscopic removal of the foreign body was successfully performed without complication. The liver abscess was treated with parenteral antibiotics without drainage. The patient’s recovery was uneventful. Abdominal ultrasonography demonstrated complete resolution of the hepatic abscess six months after discharge. Relevant literature from the PubMed database was reviewed and the clinical presentations, diagnostic modalities, treatment strategies and outcomes of 88 reported cases were analyzed. The results showed that only 6 patients received conservative treatment with parenteral antibiotics, while the majority underwent either image-guided abscess drainage or laparotomy. Patients receiving abscess drainage via laparotomy had a significantly shorter length of hospitalization compared with those undergoing image-guided drainage. There was no significant difference in age between those who survived and those who died, however, the latter presented to hospitals in a more critical condition than the former. The overall mortality rate was 7.95%.
Collapse
|
|
20
|
Jain A, Nag HH, Goel N, Gupta N, Agarwal AK. Laparoscopic removal of a needle from the pancreas. J Minim Access Surg 2013; 9:80-81. [PMID: 23741114 PMCID: PMC3673579 DOI: 10.4103/0972-9941.110968] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 12/08/2011] [Indexed: 12/27/2022] Open
Abstract
Foreign bodies inside the pancreas are rare and usually occur after the ingestion of sharp objects like fish bone, sewing needle and toothpick. Most of the ingested foreign bodies pass spontaneously through the anus without being noticed but about 1% of them can perforate through the wall of stomach or duodenum to reach solid organs like pancreas or liver. Once inside the pancreas they can produce complications like abscess, pseudoaneurysm or pancreatits. Foreign bodies of pancreas should be removed by endoscopic or surgical methods. We hereby report our experience of successful removal one a sewing needle from pancreas.
Collapse
Affiliation(s)
- Amit Jain
- Department of Gastrointestinal Surgery, Govind Ballabh Pant Hospital and MAM College, Delhi University, New Delhi, India
| | - Hirdaya Hulas Nag
- Department of Gastrointestinal Surgery, Govind Ballabh Pant Hospital and MAM College, Delhi University, New Delhi, India
| | - Neeraj Goel
- Department of Gastrointestinal Surgery, Govind Ballabh Pant Hospital and MAM College, Delhi University, New Delhi, India
| | - Nikhil Gupta
- Department of Gastrointestinal Surgery, Govind Ballabh Pant Hospital and MAM College, Delhi University, New Delhi, India
| | - Anil Kumar Agarwal
- Department of Gastrointestinal Surgery, Govind Ballabh Pant Hospital and MAM College, Delhi University, New Delhi, India
| |
Collapse
|
|
21
|
Abstract
Unintentional ingestion of a fishbone (FB) is common, especially in populations with a high consumption of seafood. In most instances, the ingested FB passes uneventfully through the gastrointestinal (GI) tract, usually within a week. However, in certain cases, the FB may become impacted and lead to complications. Awareness of these complications is important as patients usually present with nonspecific symptoms and could be unaware of having ingested an FB.
Collapse
Affiliation(s)
- Girish Bathla
- Department of Diagnostic Imaging, National University Hospital 5, Lower Kent Ridge Road, Singapore
| | | | | |
Collapse
|
|
22
|
Fish bone penetration of the duodenum extending into the pancreas: report of a case. Surg Today 2010; 40:676-8. [PMID: 20582523 DOI: 10.1007/s00595-009-4110-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Accepted: 04/13/2009] [Indexed: 12/24/2022]
Abstract
We report a case of fish bone penetration of the duodenum extending into the pancreatic head, which was successfully treated by surgery. A 73-year-old woman was admitted with upper abdominal dull pain that had persisted for 3 days. Computed tomography showed a linear calcified body, which appeared to penetrate the posterior wall of the duodenal bulb into the pancreatic head. A laparotomy was performed based on the preoperative diagnosis of localized peritonitis caused by penetration of the duodenum into the pancreas by an ingested foreign body. The foreign body was safely removed from both the pancreas and duodenum and was found to be a fish bone, measuring 4 cm in length. Neither an abscess nor hematoma was detected at the site of the pancreatic head. The postoperative course was uneventful. This case demonstrates an unusual presentation of fish bone penetration of the duodenum with a migration to the pancreas.
Collapse
|
|
23
|
Absceso hepático secundario a la impactación de un cuerpo extraño en la pared colónica. Rev Clin Esp 2010; 210:e13-5. [DOI: 10.1016/j.rce.2009.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Revised: 12/14/2009] [Accepted: 12/26/2009] [Indexed: 01/30/2023]
|
|
24
|
Leggieri N, Marques-Vidal P, Cerwenka H, Denys A, Dorta G, Moutardier V, Raoult D. Migrated foreign body liver abscess: illustrative case report, systematic review, and proposed diagnostic algorithm. Medicine (Baltimore) 2010; 89:85-95. [PMID: 20517180 DOI: 10.1097/md.0b013e3181d41c38] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Pyogenic liver abscess is a severe condition and a therapeutic challenge. Treatment failure may be due to an unrecognized ingested foreign body that migrated from the gastrointestinal tract. There has recently been a marked increase in the number of reported cases of this condition, but initial misdiagnosis as cryptogenic liver abscess still occurs in the majority of cases. We conducted the current study to characterize this entity and provide a diagnostic strategy applicable worldwide. To this end, data were collected from our case and from a systematic review that identified 59 well-described cases. Another systematic review identified series of cryptogenic-and Asian Klebsiella-liver abscess; these data were pooled and compared with the data from the cases of migrated foreign body liver abscess. The review points out the low diagnostic accuracy of history taking, modern imaging, and even surgical exploration. A fistula found through imaging procedures or endoscopy warrants surgical exploration. Findings suggestive of foreign body migration are symptoms of gastrointestinal perforation, computed tomography demonstration of a thickened gastrointestinal wall in continuity with the abscess, and adhesions seen during surgery. Treatment failure, left lobe location, unique location (that is, only 1 abscess location within the liver), and absence of underlying conditions also point to the diagnosis, as shown by comparison with the cryptogenic liver abscess series. This study demonstrates that migrated foreign body liver abscess is a specific entity, increasingly reported. It usually is not cured when unrecognized, and diagnosis is mainly delayed. This study provides what we consider the best available evidence for timely diagnosis with worldwide applicability. Increased awareness is required to treat this underestimated condition effectively, and further studies are needed.
Collapse
Affiliation(s)
- Nicola Leggieri
- From Service de Maladies Infectieuses et Laboratoire Central de Bactériologie (NL), Hôpitaux Universitaires de Genève, Geneva, Switzerland; Institut Universitaire de Médecine Sociale et Préventive (PMV), Service deRadiologie (AD), Service de Gastroentérologie et d'Hépatologie (GD), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Department of Surgery (HC), Medical University of Graz, Graz, Austria; Service de Chirurgie Viscérale (VM), Hôpital Nord, Marseille, France; and Unité des Rickettsies (DR), Centre Nationale de Recherche Scientifique, Unité Mixte de Recherche, Marseille, France
| | | | | | | | | | | | | |
Collapse
|
|
25
|
Gastric perforation by a toothpick causing a liver abscess. Eur Surg 2008. [DOI: 10.1007/s10353-008-0398-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
|
26
|
Kim YM, Lee TH, Jung SH, Kim SM, Im EH, Huh KC, Choi YW, Kang YW. Hepatic abscess that formed secondary to fish bone and had a fistula with the ascending colon. Dig Dis Sci 2007; 52:3515-8. [PMID: 17420945 DOI: 10.1007/s10620-006-9198-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2005] [Accepted: 12/01/2005] [Indexed: 12/11/2022]
Abstract
We present the case of a liver abscess that formed secondary to foreign bodies and formed a fistula the ascending colon and was successfully treated with percutaneous abscess drainage and colonoscopic removal of foreign bodies. A 64-year-old man presented with right upper and lower quadrant pain of 2 weeks' duration. Abdominal computed tomography was performed, demonstrating a single 3.5 x 1.9-cm abscess of the liver's right lobe and eccentric thickening of the colon wall at hepatic flexure. A percutaneous hepatic drainage catheter was placed under ultrasound guidance. Colonoscopic examination revealed multiple diverticula of the ascending colon and two 1.5-cm long fish bones at the ascending colon near the hepatic flexure. One end of each fish bone had impacted the edematous colonic mucosa and was surrounded by exudate polypoid inflammatory tissue. The fish bones were extracted with forceps. The patient was feeling well and was discharged after 12 days of treatment.
Collapse
Affiliation(s)
- Yong Moon Kim
- Department of Internal Medicine, Konyang University College of Medicine, 685 Gasoowon-dong Seo-gu, Daejeon, Korea
| | | | | | | | | | | | | | | |
Collapse
|
|
27
|
Ruptured hepatic abscess caused by fish bone penetration of the duodenal wall: report of a case. Surg Today 2007; 37:1018-21. [PMID: 17952539 DOI: 10.1007/s00595-007-3524-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2006] [Accepted: 02/02/2007] [Indexed: 12/14/2022]
Abstract
The accidental ingestion of a foreign body into the gastrointestinal tract is not uncommon; however, the development of a hepatic abscess secondary to foreign body perforation is extremely rare. We report the case of a ruptured hepatic abscess caused by fish bone penetration of the duodenal bulb, resulting in generalized peritonitis. A 73-year-old man was admitted to our hospital with generalized abdominal pain and high fever. Computed tomography of the abdomen showed ascites and a heterogeneously enhanced mass with a less-dense center and a linear dense object. We diagnosed a ruptured hepatic abscess caused by a calcified foreign body, which was managed by peritoneal lavage, drainage of the hepatic abscess, and removal of the fish bone, followed by simple closure of the hepatoduodenal fistula. The patient's postoperative course was complicated by systemic inflammatory response syndrome, but he recovered eventually.
Collapse
|
|
28
|
|
|
29
|
Santos SA, Alberto SCF, Cruz E, Pires E, Figueira T, Coimbra E, Estevez J, Oliveira M, Novais L, Deus JR. Hepatic abscess induced by foreign body: Case report and literature review. World J Gastroenterol 2007; 13:1466-70. [PMID: 17457985 PMCID: PMC4146938 DOI: 10.3748/wjg.v13.i9.1466] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hepatic abscess due to perforation of the gastrointestinal tract caused by ingested foreign bodies is uncommon. Pre-operative diagnosis is difficult as patients are often unaware of the foreign body ingestion and symptoms and imagiology are usually non-specific. The authors report a case of 62-year-old woman who was admitted with fever and abdominal pain. Further investigation revealed hepatic abscess, without resolution despite antibiotic therapy. A liver abscess resulting from perforation and intra-hepatic migration of a bone coming from the pilorum was diagnosed by surgery. The literature concerning foreign body-induced perforation of the gastrointestinal tract complicated by liver abscess is reviewed.
Collapse
Affiliation(s)
- Sofia A Santos
- Department of Gastroenterology, Fernando Fonseca Hospital, Amadora 2720-276, Portugal.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
30
|
Goh BKP, Tan YM, Lin SE, Chow PKH, Cheah FK, Ooi LLPJ, Wong WK. CT in the preoperative diagnosis of fish bone perforation of the gastrointestinal tract. AJR Am J Roentgenol 2006; 187:710-714. [PMID: 16928935 DOI: 10.2214/ajr.05.0178] [Citation(s) in RCA: 127] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Foreign body perforation of the gastrointestinal (GI) tract has diverse clinical manifestations, and the correct preoperative diagnosis is seldom made. We report our experience with the use of CT in the preoperative diagnosis of fish bone perforation of the GI tract in seven patients. To our knowledge, this series is the largest to date addressing the role of CT in the diagnosis of fish bone perforation. CONCLUSION Clinical presentation and radiography are unreliable in the preoperative diagnosis of fish bone perforation of the GI tract. This limitation can be overcome with the use of CT, which is accurate in showing the offending fish bone. The accuracy of CT is limited by observer dependence. A high index of suspicion should always be maintained for the correct diagnosis to be made.
Collapse
Affiliation(s)
- Brian K P Goh
- Department of Surgery, Singapore General Hospital, Outram Road, Singapore 169608.
| | | | | | | | | | | | | |
Collapse
|
|
31
|
Goh BKP, Chow PKH, Quah HM, Ong HS, Eu KW, Ooi LLPJ, Wong WK. Perforation of the gastrointestinal tract secondary to ingestion of foreign bodies. World J Surg 2006; 30:372-377. [PMID: 16479337 DOI: 10.1007/s00268-005-0490-2] [Citation(s) in RCA: 209] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Ingesting a foreign body (FB) is not an uncommon occurrence. Most pass through the gastrointestinal (GI) tract uneventfully, and perforation is rare. The aim of this study was to report our experience with ingested FB perforations of the GI tract treated surgically at our institution. METHODS A total of 62 consecutive patients who underwent surgery for an ingested FB perforation of the GI tract between 1990 and 2005 were retrospectively reviewed. Three patients with no definite FB demonstrated intraoperatively were included. RESULTS The patients had a median age of 58 years, and 37 (60%) were male. Of the 59 FBs recovered, 55 (93%) were toothpicks and dietary FBs such as fish bones or bone fragments. A definitive preoperative history of FB ingestion was obtained for only two patients, and 36 of 52 patients (69%) wore dentures. Altogether, 18 (29%) perforations occurred in the anus or distal rectum, and 44 perforations were intraabdominal, with the most common abdominal site being the distal ileum (39%). Patients with FB perforations in the stomach, duodenum, and large intestine were significantly more likely to be afebrile (P = 0.043), to have chronic symptoms (> 3 days) (P < 0.001), to have a normal total white blood cell count (P < 0.001), and to be asymptomatic or present with an abdominal mass or abscess (P < 0.001) compared to those with FB perforations in the jejunum and ileum. CONCLUSIONS Ingested FB perforation in the adult population is most commonly secondary to unconscious accidental ingestion and is frequently caused by dietary FBs especially fish bones. A preoperative history of FB ingestion is thus rarely obtained, although wearing dentures is a common risk factor. FB perforations of the stomach, duodenum, and large intestine tend to present with a longer, more innocuous clinical picture than perforations in the jejunum or ileum.
Collapse
Affiliation(s)
- Brian K P Goh
- Department of Surgery, Singapore General Hospital, Outram Road, 169608, Singapore.
| | | | | | | | | | | | | |
Collapse
|