Pelvic osseous foreign body identified during laparoscopic appendectomy in a child with acute appendicitis: a case...

Acute appendicitis (AA) is among the most frequent surgical emergencies in children, and laparoscopic appendectomy is widely accepted as the standard treatment. During imaging evaluation for pediatric acute abdomen, incidental pelvic abnormalities may occasionally be identified and can complicate perioperative decision-making. We report a rare case of acute suppurative appendicitis in a child with an unexpected pelvic osseous foreign body detected on preoperative computed tomography (CT).

An 8-year-6-month-old girl presented with a 2-day history of intermittent abdominal pain accompanied by fever. Abdominal CT performed at a local hospital suggested acute appendicitis and additionally revealed a linear hyperdense structure measuring approximately 4.0 cm between the bladder and uterus. Emergency laparoscopic appendectomy was subsequently performed after admission.

During laparoscopic exploration, a bone-like foreign body approximately 4.0 cm in length was identified at the pelvic peritoneal reflection without obvious surrounding inflammation or adhesions. Following intraoperative communication with the patient's family and acquisition of informed consent, the foreign body was removed simultaneously. Histopathological examination of the foreign body was declined by the family.

The postoperative course was uneventful, and the patient was discharged on postoperative day 5. Histopathological analysis confirmed acute suppurative appendicitis. At both 1- and 3-month follow-up visits, the patient remained asymptomatic with normal diet, sleep, and bowel function.

This case highlights the importance of careful assessment of incidental findings encountered during the management of pediatric acute abdomen. When intraoperative findings are technically accessible and clinically meaningful, simultaneous management may be considered after adequate evaluation and informed consent.