Silent perforations of the stomach and duodenum by needles

Abstract

We present a series of ten patients consecutively admitted to the hospital after swallowing 12 household sewing needles. Ten of these needles, one in each patient, had perforated either the stomach or the duodenum, but in no case did the perforation cause any abdominal symptoms or signs. Immediately after arrival in the emergency ward, the diagnosis was made in most cases by means of a diatrizoate meglumine swallow, which showed the tip of the needle protruding outside the gastrointestinal tract. In the first few cases, the diagnosis was made by finding the needle in the same position after repeated plain abdominal roentgenograms. This method, however, served to delay the diagnosis of perforation. All patients were operated on immediately after the diagnosis of perforation was made, except for two who had an additional ingested needle. Operation was delayed in these patients until the second needle was spontaneously eliminated. Perforation was confirmed by operation in all cases in the present series, the operative extraction of the needle was simple, and recovery was uneventful. The fact that patients may remain asymptomatic despite perforation of their stomach or duodenum by sharp, fine foreign bodies is no cause for procrastination of surgery, as severe complications may subsequently result.