Small Bowel Perforation due to Ingested Foreign body
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CASE REPORT
Small Bowel Perforation due to Ingested Foreign body Bakalis A, Petropoulos K, Zervas K, Efthimiou M
Abstract Small bowel perforation due to ingested foreign body is a rare but potentially life-threatening event. We present here 4 cases of small intestinal perforation caused by accidental ingestion of foreign bodies, from a total of 1,100 surgical procedures in one unit over a one-year period (September 2016 - August 2017). All 4 cases occurred in elderly patients who were using an artificial denture. The clinical appearance was that of acute abdomen, and in one case there had been formation of an enterocutaneous fistula a long time after the foreign body was swallowed. Typically, preoperative abdominal computed tomography (CT) showed the possible presence of a foreign body, which was confirmed intraoperatively. All 4 patients underwent surgery. Removal of the foreign body was performed, followed by primary intestinal closure or small bowel resection with a side-to-side anastomosis. Three of the 4 patients had an uneventful postoperative course, but one died on the 10th postoperative day, due to a severe postoperative pulmonary infection. Old age and artificial denture use appear to be strong risk factors, and the time and location of the perforation, and the presence of co-morbidities are prognostic factors for a successful surgical outcome. The choice of the type of surgery is individualized. A high level of clinical suspicion and meticulous investigation of the entire small intestine are required to ensure the correct diagnosis and early intervention for a successful outcome. Key words: Perforation; foreign body; peritonitis; acute abdomen; bowel resection; elderly
Introduction
Aim
Small bowel perforation caused by a foreign body is a rare but very serious clinical entity in the field of emergency surgery. It usually has an atypical presentation in terms of the clinical picture, risk factors, site of perforation, radiological features and intraoperative findings, and its prognosis and outcome are varied [1,2]. Because the presentation is non-specific and there is a latent period between ingestion of the foregn body and perforation, the condition is often misdiagnosed [3]. The involuntary and accidental swallowing of foreign bodies usually involves children or elderly persons with mental or swallowing disorders and/ or artificial dentures. Most ingested foreign bodies can be spontaneously passed through the alimentary tract with no complications, but, depending on its nature (size, shape, sharpness), a foreign body may, in rare cases, cause major complications such as obstruction, hemorrhage and perforation [4,5].
We present our recent experience concerning the diagnosis and treatment of 4 cases of intestinal perforation due to ingested foreign bodies, with an attempt to identify possible risk and prognostic factors and to summarize the different types of surgical treatment.
Bakalis A, Petropoulos K, Zervas K, Efthimiou M Department of General Surgery, Larissa General Hospital “Koutlimpaneio an
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