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Milk Collection Methods for Mice and Reeves' Muntjac Deer
Published on: July 19, 2014
The mule who took us for a ride
Islam El-Abbassy1, Benjamin Perakath2
1ST General Surgery, Department of General Surgery, NHS Grampian, UK; Honorary Associate, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK.
Abstract:
Foreign body ingestion is not uncommon in patients with mental disorders, alcohol intoxication and for purposes of drug trafficking. Small objects pass spontaneously; however, larger ones may get stuck in the oesophagus, stomach or at narrow areas of the bowel. 'Body packers' is a term used to describe persons who swallow or insert drug-filled packets into a body cavity. They are also called 'swallowers', 'internal carriers', 'couriers' or 'mules'. We report a 37-year-old previous drug abuser who presented with dysphagia. Upper GI endoscopy showed an oblong foreign body covered in plastic in the lower oesophagus. This could not be extracted and hence was pushed into the stomach. Three weeks later, he presented with bowel obstruction that was shown on abdominal radiograph and confirmed by CT indicating multiple dilated small bowel loops with a transition point in the terminal ileum where the ingested package was identified. The package was then removed through a longitudinal enterotomy. Ingested foreign bodies causing dysphagia should ideally be extracted endoscopically. If not possible, then a watch-and-wait policy may be justified. While most ingested objects pass spontaneously, unusual and larger ones may require surgical extraction. The contents, nature and reason for ingesting this strange object remain a mystery. With history of drug abuse and the consistent denial of knowingly swallowing that object, we can only conclude that the patient was trying to transport an illicit drug in the packet.
Insights
Foreign body ingestion, often linked to drug trafficking, can cause serious complications like bowel obstruction. This case highlights the need for prompt diagnosis and management of ingested packets, even when the patient denies intentional swallowing.
Area of Science:
- Gastroenterology
- Toxicology
- Radiology
Background:
- Foreign body ingestion is a known risk in individuals with substance abuse disorders and for illicit drug concealment.
- Swallowing foreign objects can lead to esophageal, gastric, or intestinal impaction, necessitating medical intervention.
Observation:
- A 37-year-old male with a history of drug abuse presented with dysphagia.
- Endoscopy revealed an esophageal foreign body, which was pushed into the stomach due to extraction difficulties.
- Radiographic and CT imaging confirmed a small bowel obstruction caused by the ingested packet in the terminal ileum.
Findings:
- The ingested packet, suspected to be illicit drugs, caused a significant bowel obstruction three weeks after initial presentation.
- Surgical intervention via enterotomy was required for the removal of the foreign body.
- Endoscopic removal is preferred for esophageal foreign bodies, but surgical extraction may be necessary for complex cases or intestinal impaction.
Implications:
- This case underscores the diagnostic challenges and potential complications associated with body packing, particularly in patients with a history of substance abuse.
- Physicians should maintain a high index of suspicion for foreign body ingestion in patients presenting with obstructive symptoms, even with denial.
- Multimodality imaging and timely surgical consultation are crucial for managing ingested foreign bodies that cause intestinal obstruction.
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