Laparoscopic retrieval of an unusual foreign body
Binay Kumar Shukla, Rajesh Khullar, Anil Sharma, Vandana Soni, Manish Baijal, and Pradeep Chowbey Author information Article notes
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Foreign body ingestion is a common cause of accidental death. Although approximately 90% of them pass spontaneously, they can result in perforation or obstruction in the gastrointestinal (GI) tract. Toddlers aged 2-3 years are most commonly affected; as children in this age group are ambulatory and more orally explorative. Intestinal perforation by a foreign body is uncommon occurring in <1% of patients. It normally affects the ileocaecal and rectosigmoid regions. According to Goh et al., the most common site of intra-abdominal perforation as the terminal ileum (approximately 39%).
We present a case of young female with ingestion of foreign body which was impacted in a small intestine.
A 23-year-old female presented to the emergency of the Max Super Speciality Hospital, Saket, New Delhi, India with a history of ingestion of teaspoon, while she was eating ice cream 1 day before. She complained of pain abdomen and nausea. Physical examination revealed soft abdomen with mild tenderness around umbilicus and no signs of peritonitis. A plain X-ray abdomen revealed presence of a radio-opaque foreign body (metallic teaspoon) in the stomach. Initially, we decided to observe and closely monitor the patient after admitting her and starting conservative expectant treatment. The next day she was not relived, and the abdominal pain continued. In view of that, we took the decision to proceed with diagnostic laparoscopy. Repeat X-ray abdomen was performed in erect and supine position to locate the position of the teaspoon [Figure 1].
Diagnostic laparoscopy was performed with one 10 mm and two 5 mm midline ports. On initial evaluation, the bowels looked normal. There were no bowel adhesions. On the exploration and careful examination of upper GI tract jejunum was found to be dilated. On tracing the loop of jejunum, the spoon was located at the mid jejunal level. Enterotomy was performed on the antimesenteric border, and tablespoon identified and was retrieved [Figures 2 and 3]. Enterotomy closed with Endo GI stapler.
Patient had an uneventful post-operative recovery and was ultimately discharged on post-operative day 4.