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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.
The New Zealand Medical Journal
|September 30, 2020
Summary
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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