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An Interesting Cause of Mechanical Small Bowel Obstruction
Sandeep Anantha Sathyanarayana1, Gary B Deutsch1, Barak Friedman2
1Department of Surgery, Hofstra-NSLIJ School of Medicine, 300 Community Drive, Manhasset, NY 11030 USA.
Insights
Foreign body ingestion in children can cause abdominal pain. This case highlights successful surgical extraction of a radiolucent foreign body diagnosed using 3D-CT, preventing complications from intestinal obstruction.
Area of Science:
- Pediatric Gastroenterology
- Pediatric Surgery
- Radiology
Background:
- Foreign body ingestion is a common cause of abdominal pain in children aged 6 months to 3 years.
- While most foreign bodies pass spontaneously, some require endoscopic or surgical intervention, especially with intestinal obstruction.
- Radiopaque foreign bodies are identified on plain radiography, while radiolucent ones require advanced imaging.
Purpose of the Study:
- To present a case of pediatric foreign body ingestion with intestinal obstruction.
- To emphasize the diagnostic utility of 3D-CT in identifying radiolucent foreign bodies.
- To highlight the importance of timely surgical intervention for foreign body-induced obstruction.
Main Methods:
- Initial assessment with plain abdominal radiography.
- Computed tomography with 3D reconstruction (3D-CT) for suspected radiolucent foreign bodies.
- Surgical extraction for foreign body causing intestinal obstruction after failed conservative management.
Main Results:
- A radiolucent foreign body was successfully diagnosed using 3D-CT.
- The patient underwent surgical extraction of the foreign body.
- Timely surgical intervention effectively relieved the intestinal obstruction.
Conclusions:
- 3D-CT is a valuable tool for diagnosing radiolucent foreign bodies in children.
- Surgical intervention is crucial for managing intestinal obstruction caused by ingested foreign bodies.
- Prompt management prevents serious complications associated with foreign body ingestion.
Abstract:
Foreign body ingestion is a known cause of abdominal pain in pediatric population occurring between 6 months and 3 years of age (Wyllie Curr Opin Pediatr 18:563, 2006, Uyemura Am Fam Physician 72:287, 2005, Banerjee Indian J Pediatr 72:173, 2005). Most of the ingested foreign bodies pass spontaneously with 10-20 % requiring endoscopic retrieval, and <1 % of cases require a surgical intervention (Wyllie Curr Opin Pediatr 18:563, 2006, Uyemura Am Fam Physician 72:287, 2005, Shivakumar Indian J Pediatr 71:689, 2004). Presence of intestinal obstruction necessitates surgical intervention to extract the ingested foreign body. Initial abdominal plain radiograph should be obtained when foreign body ingestion is suspected, which differentiates a radiopaque from radiolucent foreign bodies. A computed tomography with 3D reconstruction (3D-CT) is recommended with radiolucent foreign bodies (Uyemura Am Fam Physician 72:287, 2005, Kazam Am J Emerg Med 23:897, 2005). After 24 h of expectant management, failure of spontaneous passage requires further intervention. Timely intervention to relieve the obstruction is pivotal to prevent undue complications. We present an interesting case of a boy who ingested a radiolucent foreign body diagnosed on 3D-CT, successfully treated with surgical extraction.
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