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. 2016 Sep-Oct;49(5):295-299.
doi: 10.1590/0100-3984.2015.0127.

Intestinal perforation by an ingested foreign body

Gabriel Cleve Nicolodi  1 , Cesar Rodrigo Trippia  2 , Maria Fernanda F S Caboclo  2 , Francisco Gomes de Castro  1 , Wagner Peitl Miller  1 , Raphael Rodrigues de Lima  1 , Leandro Tazima  1 , Jamylle Geraldo  1
Affiliations

Intestinal perforation by an ingested foreign body

Gabriel Cleve Nicolodi et al. Radiol Bras. 2016 Sep-Oct.

Abstract
in English, Portuguese

Objective: To identify the computed tomography findings suggestive of intestinal perforation by an ingested foreign body.

Materials and methods: This was a retrospective study of four cases of surgically proven intestinal perforation by a foreign body, comparing the computed tomography findings with those described in the literature.

Results: None of the patients reported having ingested a foreign body, all were over 60 years of age, three of the four patients used a dental prosthesis, and all of the foreign bodies were elongated and sharp. In all four patients, there were findings indicative of acute abdomen. None of the foreign bodies were identified on conventional X-rays. The computed tomography findings suggestive of perforation were thickening of the intestinal walls (in all four cases), increased density of mesenteric fat (in all four cases), identification of the foreign body passing through the intestinal wall (in three cases), and gas in the peritoneal cavity (in one case).

Conclusion: In cases of foreign body ingestion, intestinal perforation is more common when the foreign body is elongated and sharp. Although patients typically do not report having ingested such foreign bodies, the scenario should be suspected in elderly individuals who use dental prostheses. A computed tomography scan can detect foreign bodies, locate perforations, and guide treatment. The findings that suggest perforation are thickening of the intestinal walls, increased mesenteric fat density, and, less frequently, gas in the peritoneal cavity, often restricted to the point of perforation.

Objetivo: Identificar os achados tomográficos sugestivos de perfuração intestinal por corpo estranho alimentar.

Materiais e métodos: Foram avaliados, retrospectivamente, quatro casos de perfuração intestinal por corpo estranho comprovados cirurgicamente, e comparados os achados tomográficos com os descritos na literatura.

Resultados: Nenhum dos pacientes referiu a ingestão do corpo estranho, todos tinham mais de 60 anos, três usavam prótese dentária e todos os objetos eram alongados e pontiagudos. Os quatro apresentaram abdome agudo, o corpo estranho não foi identificado pela radiografia simples em nenhum deles, e os achados tomográficos sugestivos de perfuração foram espessamento das paredes da alça intestinal (nos quatro casos), densificação da gordura mesentérica (nos quatro casos), identificação do corpo estranho transfixando a parede intestinal (em três casos) e gás na cavidade peritoneal (em um caso).

Conclusão: Perfuração intestinal é mais comum em casos de objetos pontiagudos e alongados, em que os pacientes, geralmente, não referem a ingestão, mas deve-se suspeitar em idosos que usam próteses dentárias. A tomografia permite detectar corpos estranhos, localizar a perfuração e orientar o tratamento. Os achados que sugerem perfuração são espessamento das paredes de um segmento intestinal, edema da gordura mesentérica e, menos frequentemente, gás na cavidade peritoneal, muitas vezes limitado ao ponto da perfuração.

Keywords: Abdomen, acute; Foreign bodies; Intestinal perforation; Intestine, small; Tomography, X-ray computed.

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Figures

Figure 1
Figure 1
A 64-year-old female patient. A: The foreign body was not detected on routine X-rays. B: A CT scan of the abdomen showed a sharp foreign body (arrow), with the appearance of a fish bone, piercing the intestinal wall in the ileal segment within the pelvic cavity, accompanied by thickening of the intestinal wall and increased density of the adjacent mesenteric fat.
Figure 2
Figure 2
A 68-year-old male patient with severe abdominal pain. A: A CT scan of the abdomen showing a sharp foreign body (arrow) in the distal ileal segment, together with thickening of the intestinal wall. B: During the surgical procedure, a chicken bone fragment (arrow) was found to be piercing the intestinal wall and the affected intestinal segment was resected.
Figure 3
Figure 3
A 83-year-old female patient. A CT scan of the abdomen showing inflammatory impaction in the pelvic cavity. Surgery confirmed intestinal perforation by a toothpick, which was detected (retrospectively) as an image with a slightly higher density than the surrounding tissue, piercing the intestinal wall (arrow)
Figure 4
Figure 4
A 74-year-old male patient. A CT scan of the abdomen, showing a foreign body piercing the wall of the ileal loop in the pelvic region (A, arrow), with thickening of the intestinal wall, increased mesenteric fat density, and free gas in the peritoneal cavity, indicating intestinal perforation. Note also the nodular lesion with soft parts protruding into the intestinal lumen at the point of the foreign body impaction (B, arrow). Surgery revealed a neuroendocrine tumor in the intestinal wall, resulting in narrowing of the lumen, at the point of perforation by a fish bone.
See this image and copyright information in PMC

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