Answer
From question on page 379
Computed tomography (CT) scan showed an abscess in the omental bursa bulging in the posterior wall of the stomach (fig 1). An intragastric sharp foreign body was identified as passing through the posterior wall of the stomach and penetrating into the abscess (fig 2).
Gastroscopy was then performed which revealed the presence a penetrating piece of glass in the antral segment of the stomach that was retrieved with a biopsy forceps (fig 3). At first, a perinephric abscess was suspected; CT scan allowed diagnosis of a subphrenic abscess that was secondary to direct contamination of the area following a stomach injury. When the patient was reinterrogated, he admitted that he had eaten quickly a delivered chicken sandwich two days before he presented with renal colic. Percutaneous drainage with antibiotic treatment led to resolution of the abscess. The patient was discharge 10 days later after a total recovery.
Many cases of gastric perforation with peritonitis, subphrenic abscesses, pylephlebitis, hepatic abscesses, or lethal bleeding caused by ingested long and sharp objects are reported in the literature. Endoscopic removal of these sharp objects must be considered as soon as ingestion is reported. The peculiarity of this case is that the patient was unaware that he had swallowed the piece of glass and the symptoms were masked by renal colic and antibiotic treatment.
Figure 3 Identification on gastroscopy of a penetrating piece of glass which was retrieved with a biopsy forceps.