A bizarre foreign body in the appendix: A case report

Abstract

Foreign bodies are rare causes of appendicitis and, in most cases, ingested foreign bodies pass through the alimentary tract asymptomatically. However, ingested foreign bodies may sometimes remain silent within the appendix for many years without an inflammatory response. Despite the fact that cases of foreign-body-induced appendicitis have been documented, sharp and pointed objects are more likely to cause perforations and abscesses, and present more rapidly after ingestion. Various materials, such as needles and drill bits, as well as organic matter, such as seeds, have been implicated as causes of acute appendicitis. Clinical presentation can vary from hours to years. Blunt foreign bodies are more likely to remain dormant for longer periods and cause appendicitis through obstruction of the appendiceal lumen. We herein describe a patient presenting with a foreign body in his appendix which had been swallowed 15 years previously. The contrast between the large size of the foreign body, the long clinical history without symptoms and the total absence of any histological inflammation was notable. We suggest that an elective laparoscopic appendectomy should be offered to such patients as a possible management option.

Keywords: Abdominal pain; Acute appendicitis; Appendectomy; Calcified fecaloma; Foreign body; Laparoscopy.

Figure 1

Abdominal pain. A: Lower abdomen X-ray shows a rounded radio-opaque formation in the right iliac fossa; B: Lower abdomen computed tomography showing a roundish-filling defect in right iliac fossa; C: Laparoscopic intraoperative view of the dilated appendix due to the presence of a foreign body; D: The marrowbone included in a calcified fecaloma.