Intestinal perforation from ingested fishbone

We report five cases of acute perforation of the intestine by ingested fishbone in each of which the bone has been found within the abdomen.The site of perforation in two cases was a Meckel's diverticulum, in one case probably the appendix. The incidence of perforation in these blind segments is explained by their inability to rid themselves of the offending bone. Once it has entered, peristalsis forces it onward.Cases 1 and 11 prove that when a perforating fishbone of small caliber is completely extruded from the intestine or falls back into the lumen so that the bone no longer pierces the wall of the intestine, the lesion made by it tends to close spontaneously without leakage, without peritonitis and without trauma of sufficient degree to mark the site.An extruded fishbone tends to migrate and may cause an abscess far removed from the site of perforation.Case v is unusual in that penetration of the internal iliac vein by the perforating bone was followed by fatal blood stream infection.     

Intestinal perforation by foreign bodies.

OBJECTIVE: To present our experience of patients who presented with intestinal perforation by foreign bodies to our hospital between 1980 and 1998. DESIGN: Retrospective study. SETTING: University hospital, Spain. SUBJECTS: 21 patients who presented with intestinal perforation by foreign bodies. MAIN OUTCOME MEASURES: Size of perforations, nature of foreign bodies, clinical symptoms, radiological findings, treatment and outcome. RESULTS: The most common location was the terminal ileum (n = 11), followed by the rectosigmoid junction (n = 5). The objects were mainly bone fragments and toothpicks. The diagnosis was generally made at operation, and only 4 of the 21 patients had signs of pneumoperitoneum on the preoperative abdominal film. The most common treatment was simple suture of the defect. CONCLUSIONS: Intestinal perforation by a foreign body is uncommon, and normally affects the ileocaecal and rectosigmoid regions, in which it is unusual to find pneumoperitoneum preoperatively. It must be considered in the differential diagnosis of such conditions as acute appendicitis and diverticulitis.     

Retroperitoneal abscess due to asymptomatic duodenal perforation by foreign body. A case report

We present a case of retroperitoneal abscess due to asymptomatic duodenal perforation by foreign body. Patient has been admitted for lumbar pain and subocclusive crisis, with a medical history negative for acute symptomatology. After both clinical and radiologic evaluation, an abscess-like mass was detected in the context of right psoas muscle. Patient underwent surgical operation and a lumbar abscess has been found containing a foreign body (toothpick). There has been a transduodenal migration of the foreign body, without clinical signs of duodenal perforation.     

Recurrent brain abscess due to an unexpected foreign body.

We report an exceptional case of a patient with chronic frontal sinusitis complicated by chronic osteomyelitis and a cutaneous fistula. A recurrent brain abscess developed and was only cured after a very unusual wooden retained foreign body was removed at surgery. The hazards of wood as a foreign body are discussed and it is stressed that the possibility of a retained foreign body, even unsuspected, must always be borne in mind.     

Double esophageal perforation by ingested foreign body: Endoscopic and surgical approach. A case report.

IntroductionEsophageal perforation in adults is most frequently caused by ingested foreign bodies. They can migrate through the esophageal wall, damaging the nearby organs such as the aorta or the trachea, with fatal outcome. After the diagnosis, the viable treatments for extracting the foreign body and repairing the perforation are several. The appropriate treatment, may be endoscopic, surgical or combined, depending on the level of the perforation, on the co-morbidities of the patient and on the available resources.Presentation of caseThis paper describes a case of a 68 years old patient with a double EP caused by a meat-bone that perforated the thoracic esophageal wall, approaching the aorta on the left side and the azygos vein on the right side.DiscussionBecause of the double transfixion and the position near the aorta and the azygos, it was not possible to remove safely the bone during the endoscopy. The management required a combined endoscopic and surgical approach. This way it was possible to detect easily the location of the perforation, to remove safely the foreign body, to repair the perforation both from the outside and from the inside, and to place the nasogastric tube under direct vision.ConclusionEven when the type of esophageal perforation requires surgical treatment, the simultaneous use of endoscopy proved to be an advantage in order to extract the foreign body safely, to perform a double repair of the perforation and to place the nasogastric tube under direct vision.     

Transluminal migration of ingested foreign body without peritonitis

The authors present 2 cases of transluminal migration of an ingested foreign body into the peritoneal cavity without causing peritonitis. Clinical and radiologic features and surgical approach are described, focusing on the absence of an acute abdomen in transluminal migration and the use of laparoscopy in achieving extraction of the foreign object.     

Unusual liver abscess secondary to ingested foreign body: laparoscopic management

Liver abscess is a cause of febrile abdominal pain and usually the origin of a liver abscess is ascending cholangitis, hemathological diffusion, via the portal vein or the hepatic artery, or superinfection of necrotic tissue. Solitary pyogenic abscess with no obvious systemic cause may be secondary to a local event such as the migration of an ingested foreign body.We report the case of a solitary liver abscess caused by an ingested foreign body, a fish bone, migrated through the gastric wall into the left lobe.     

Intestinal perforation due to phytobezoar obstruction: a case report

Phytobezoars are uncommon causes of acute abdomen. We report a patient who presented with acute abdomen and who was intra-operatively diagnosed as having a small intestinal perforation due to an intestinal phytobezoar.