Laparoscopic management of sealed gastric perforation caused by an ingested foreign body: A case report

Foreign body ingestion is common in prison, psychiatric, and pediatric populations. While most cases resolve without intervention, about 20 % require endoscopic or surgical removal. Perforation, occurring in 1 % of cases, is a serious complication that may spontaneously seal. We report a case of spontaneously sealed gastric perforation managed laparoscopically, emphasizing diagnostic challenges and the potential irrelevance of localizing and repairing such perforations.

A 38-year-old male presented with severe abdominal pain, nausea, and fever for two days. Computed Tomography (CT) revealed a foreign body causing a sealed gastric perforation with an associated abscess. Endoscopic retrieval failed due to non-visualization of the foreign body within the lumen, necessitating laparoscopic removal. Intraoperatively, dense adhesions between the stomach, omentum, and liver capsule suggested that the perforation had sealed spontaneously, making localization of the defect difficult. The foreign body was retrieved, and surrounding collections were drained. Given the dense adhesions, no attempt was made to identify or repair the perforation site, which was presumed sealed. The patient recovered uneventfully and regained full functional capacity within three weeks.

Foreign body ingestion is often asymptomatic but can result in peritonitis, obstruction, abscess, or hemorrhage. Diagnosis is challenging and typically requires CT due to the low sensitivity of X-rays. Management depends on clinical severity, with endoscopy preferred initially and surgery for complicated cases. Spontaneous perforation closure is common and may not require localization or repair if the defect is not clearly visible.

Repair may be unnecessary if sealed gastric perforation is adequately drained and the foreign body removed laparoscopically.