Gravel gut: small bowel perforation due to a blunt ingested foreign body

The ingestion of foreign bodies remains a common occurrence in children. Most ingested foreign bodies pass spontaneously, although up to 1% will result in intestinal perforation. Specific foreign bodies such as sharp, pointed, or corrosive objects have been typically associated with perforation. The initial diagnosis of foreign body ingestion may be difficult in the absence of a witness, and the presentation of perforation in this situation difficult to distinguish from other causes of an acute abdomen. We report a case of ileal perforation due to a blunt ingested foreign body in a child in whom the diagnosis was unclear until laparotomy. This case highlights the difficulties in managing pediatric ingested foreign bodies, including the risk of perforation even with a blunt object.