Abstract
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.
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References
Lo Re G, Mantia FL, Picone D, et al, Small bowel perforations: what the radiologist needs to know. Semin ultrasound CT MR 2016;37:23–30.
Chen Q, Huang Y, Wu Y, et al, A comparative study of small intestinal perforation secondary to foreign body and other non-traumatic causes. Ulus Travma Acil CerrahiDerg 2015;21:107–12.
Coyte A, Tahar Aissa J, Koh HC, et al. Case of unrecognised food bone ingestion with dual site intestinal perforations. BMJ Case Rep 2016 May 21;2016. pii: bcr2015213767.
Nicolodi GC, Trippia CR, Caboclo MF, et al, Intestinal perforation by an ingested foreign body. Radiol Brasil 2016;49:295–9.
Lin XK, Wu DZ, Lin XF, et al. Intestinal perforation secondary to ingested foreign bodies: a single-center experience with 38 cases. Pediatr Surg Int 2017;33:605–8.
Tien T, Tanwar S. Ingestion of cylindrical batteries and its management. BMJ Case Rep 2017 doi: 10.1136/bcr-2016-218448.
Evans DC, Wojda TR, Jones CD, et al. Intentional ingestions of foreign objects among prisoners: A review. World J Gastrointest Endosc 2015;7:162–8.
Alfonzo MJ, Baum CR. Magnetic foreign body ingestions. Pediatr Emerg Care 2016;32:698–702.
Eliason MJ, Melzer JM, Winters JR, et al. Identifying predictive factors for long-term complications following button battery impactions: A case series and literature review. Int Pediatr Otorhinolaryncol 2016; 87:198–202.
Gachabayov M, Isaev M, Orujova L, et al. Swallowed dentures: Two cases and a review. Ann Med Surg (Lond) 2015;4:407–13.
Zouros E, Oikonomou D, Theoharis G, et al, Perforation of the cecum by a toothpick: Report of a case and review of the literature. J Emerg Med 2014;47: e133–7.
Kuo CC, Jen TK, Wen CH, et al. Medical treatment for a fish bone-induced ileal micro-perforation: A case report. World J Gastroenterol 2012;18:5994–8.
Tay GC, Chng JK, Wong WK, et al. Chicken bone perforation of an irreducible inguinal hernia: A case report and review of the literature. Hernia 2013;17:805–7.
Leggieri N, Marques-Vidal P, Cerwenka H, et al. Migrated foreign body liver abscess: Illustrative case report, systematic review, and proposed diagnostic algorithm. Medicine (Baltimore). 2010;89:85–95.
Glick WA, Simo KA, Swan RZ, et al, Pyogenic hepatic abscess secondary to endoluminal perforation of an ingested foreign body. J Gastrointest Surg 2012;16:885–7.
Santos SA, Alberto SC, Cruz E, et al, Hepatic abscess induced by foreign body: Case report and literature review World J Gastroenterol 2007;13:1466–70.
Klingler PJ, Seelig MH, DeVault KR, et al, Ingested foreign bodies within the appendix: A 100-year review of the literature. Dig Dis 1998;16:308–14.
Ghahremani GG. Radiologic evaluation of suspected gastrointestinal perforations. Radiol Clin North Am 1993;31:1219–34.
Hu J, Sun S. Endoscopic ultrasound-guided retrieval of a toothpick embedded in the stomach wall. J Clin Ultrasound 2017;45:603–4.
Fang C, Ye L, Mao X, et al. Endoscopic treatment of a sigmoid perforation caused by an ingested fish bone. Endoscopy 2017;49(S 01): E82–E83.
Hur H, Song KY, Lung SE, et al. Laparoscopic removal of bone fragment causing localized peritonitis by intestinal perforation: A report of 2 cases. Surg Laparosc Endosc Percutan Tech 2009;19: e241–3.
Govind G, Siriwardana HPP, Sdralis E, et al. Chronic ileitis with transmural migration of ingested foreign body treated by laparoscopy. Acta Chir Belg 2017;17:1–5.
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Bakalis, A., Petropoulos, K., Zervas, K. et al. Small Bowel Perforation due to Ingested Foreign body. Hellenic J Surg 90, 41–45 (2018). https://doi.org/10.1007/s13126-018-0434-6
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DOI: https://doi.org/10.1007/s13126-018-0434-6