Clam ingestion: unusual cause of large bowel obstruction
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CE - LETTER TO THE EDITOR
Clam ingestion: unusual cause of large bowel obstruction Cristina Ferreira1 · Paula Gomes1 Received: 16 August 2020 / Accepted: 12 September 2020 © Società Italiana di Medicina Interna (SIMI) 2020
Dear Editor, We read with interest, the article written by Alessia Urru et al. entitled “An unusual cause of large bowel perforation: ingestion of a clam valve” [1], and we absolutely agree with the significant clinical value of the published case report [1]. Considering the rarity of these cases as clinical manifestations of large bowel complications, we would like to present a recent and curious case of a patient with large bowel obstruction due to ingestion of two whole clams and add more discussion about the clinical relevance of this entities. A 40-year-old mental impairment patient was admitted to the emergency department for behavioral changes with about 2 weeks of evolution. The patient was agitated, but without changes in vital parameters. Blood investigations and urinalysis were normal. At our department, plain abdominal radiography revealed an unexpected finding with two radio dense images in the bowel. Computed tomography was made showing two calcium-density foreign bodies in the sigmoid bowel with slight distension of proximal large bowel but without signs of acute suffering. So, CT images were compatible with obstruction caused by the presence of the foreign body without another complication. 3D MIP
reconstructions showed two “C” shape images and the largest measured 28 × 29 × 18 mm, revealing almost with certainty the nature of the foreign body: two clam shells (Fig. 1). Given their locations and absence of major complications, an enema was performed with abundant dejection and exteriorization of two whole clams, having been confirmed the diagnosis. Different objects can be lodged within the sigmoid colon, mainly with diverticulosis, the most frequently described have been: chicken bones, toothpicks, fish bones and biliary stents [2, 3]. There have been few reports related with ingestion of unsuspected foreign body, like mollusc’s valves. Moreover, almost all cases leading to pathological processes, such as inflammation and perforation [3]. We described a unique case reported in the literature of large bowel obstruction due to ingestion of two whole clams and interestingly, did not cause any more serious complications. The case reported here is really unusual due to the type of ingested foreign body, of two whole clams, which has never been previously reported to our knowledge as a cause of large bowel obstruction.
* Cristina Ferreira [email protected] 1
Serviço de Imagem Médica, Centro Hospitalar E Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000‑075 Coimbra, Portugal
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Vol.:(0123456789)
Internal and Emergency Medicine
Fig. 1 Plain abdominal radiography with upright view (a) and supine view (b) shows two radiodense images in the bowel. Computed tomography coronal acquisition without contrast showing two calcium-density foreign bodies in the sigmoid bowe
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