Perianorectal abscesses and fistula due to ingested jujube pit in infant: Two case reports

Abstract

Background: About 90% of perianal infection is caused by cryptoglandular infection. Only a few cases of peritonitis or intra-abdominal abscesses secondary to perforation of the digestive tract by an ingested foreign body have been reported. The most common sites of impaction and perforation include the appendix, cecum and the terminal ileum. The rectum is an unusual site of foreign body impaction. This report intends to highlight that ingested foreign body impacted in the rectum is an extremely rare cause of perianal abscess and subsequent fistula in infants.

Case summary: Two cases of perianal abscess and fistula due to ingested jujube pit impacted in the rectum are reported. Both cases are infants with free previous medical history suffered from recurrent perianal infection. The caregivers of the two patients denied ingestion of a foreign body or any history of trauma. Physical examination combined with ultrasound or computed tomography scan established the diagnosis. Both of the patients underwent operation under general anesthesia. In case 1, a jujube pit with sharp ends was discovered embedded within a subcutaneous fistula. The jujube pit was then removed intact along with fistula resection. The wound was successfully laid open to allow healing by secondary intention. In case 2, a jujube pit was found with its sharp end puncturing the rectum, surrounded by pus and necrotic tissue. Subsequent incision and adequate drainage were performed. The whole jujube pit was then removed from the abscess cavity at the same time. Both patients received colonoscopy to rule out inflammatory bowel disease or other potential damages by the ingested jujube pit. The postoperative period was uneventful. At 1.5 year follow-up, no recurrent abscess or fistula were found in either patient.

Conclusion: An impacted foreign body must not be overlooked as an unusual cause of perianal abscess and fistula, especially in young children.

Keywords: Case report; Foreign bodies; Infant; Nuts; Perianal abscess; Perianal fistula.

Figure 1

Preoperative abdominal computed tomography scan with intravenous contrast media administration of patient 1. Axial view (A) and intravenous contrast-enhanced axial (B), coronal (C) and sagittal (D) views showing a foreign body (arrowheads) with uneven density and brim enhancement.

Figure 2

Preoperative abdominal computed tomography scan with intravenous contrast media administration of patient 2. Axial view (A) and intravenous contrast-enhanced axial (B), coronal (C) and sagittal (D) views showing a foreign body (arrowheads) with mixed density and brim enhancement.

Figure 3

The jujube pit embedded within the fistula in patient 1.

Figure 4

Clinical timeline of patient 1. FB: Foreign body.

Figure 5

Clinical timeline of patient 2. FB: Foreign body.