Foreign Body Penetration: New Solutions for Classic Problems

Special Article - Surgical Case Reports

Austin J Surg. 2015;2(2): 1052.

Foreign Body Penetration: New Solutions for Classic Problems

Costa D*, Romero M, Caravaca I, Domenech E and Saeta R

Department of Surgery, Alicante University General Hospital, Spain

*Corresponding author: Costa D, Department of Surgery, 9th floor, Alicante University General Hospital, 12, Pintor Baeza Avenue, 03010 Alicante, Spain

Received: November 05, 2014; Accepted: January 27, 2015; Published: January 29, 2015


The aim of this paper is to present two extremely rare cases of bowel perforation due to ingested foreign bodies: the first case entailed acute abdominal wall cellulitis; in the second case, the foreign body penetrated the duodenum and extended into the hepatic artery. These have not been previously reported in the literature. In both cases, we propose the possibility of laparoscopic management for such emergencies.

Keywords: Intestinal perforation; Meckel diverticulum; Duodenum; Laparoscopy; Foreign body in alimentary tract


Foreign body perforation of the bowel occurs occasionally, in less than 10% of the cases consulting for foreign body ingestion. Surgical treatment by means of open surgery is commonly reported [1-3].

Clinical Cases

We present two extremely rare cases of foreign body penetration of the bowel with extension to neighboring organs treated by laparoscopic surgery.

Case 1

A 54-year-old male reported pain in the right lower quadrant which he had experienced for three days along with fever in the previous 24 hours. Blood tests determined leukocytosis (20,000/3) and left shift. Furthermore, abdominal examination revealed signs of cellulitis in the abdominal wall affecting the right lower quadrant. Computer Axial Tomography scan (CAT-scan) showed the presence of a foreign body that had penetrated a bowel loop and had extended to the abdominal wall. Laparoscopy was carried out and revealed the presence of a Meckel’s diverticulum perforated by a nail that had also pierced the abdominal wall (Image 1). The foreign body was removed and the portion of bowel, including the Meckel’s diverticulum, underwent resection by means of an endoscopic linear stapler (EndoGIA, Covidien®, and Mansfield, Massachusetts). Subsequently, semi-mechanical anastomosis was performed by using an endoscopic linear stapler (EndoGIA, Covidien®) and 3/0 synthetic monofilament absorbable suture. The cellulitis of the abdominal wall was treated by administering the patient broad-spectrum antibiotics over a seven day period. The postoperative course was unremarkable and the patient was discharged on the fourth postoperative day. Following surgery it was ascertained that the patient had swallowed the nail accidentally; nevertheless, he mentioned that he frequently puts nails in his mouth due to his job as a picture framer. At a subsequent review in the outpatients´ clinic two weeks later, the cellulitis had completely disappeared. Two years later, the patient remains non-symptomatic.