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Case Reports
. 2019 Sep 10;19(1):132.
doi: 10.1186/s12893-019-0594-5.

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

Chi Li  1 , Chee-Chien Yong  2 , Domelle Dave Encarnacion  2
Affiliations
Case Reports

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

Chi Li et al. BMC Surg. .

Abstract

Background: Foreign 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 presentation: A 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.

Conclusions: Negative 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.

Keywords: Duodenum; Foreign body; Perforation.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Abdominal computed tomography at the time presentation. A long, radiopaque foreign object was found in the second portion of duodenum piercing into retroperitoneal cavity. a) Coronal view b) Sagittal view
Fig. 2
Fig. 2
Operative findings. a) Chopstick identified by approaching second portion of duodenum via Cattell-Braasch maneuver b) Debridement was done to remove inflammatory tissue c) Primary duodenorrhaphy with Prolene 3–0 suture d) The 11 cm swallowed chopstick
See this image and copyright information in PMC

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