Description
Eighty to 90% of ingested foreign bodies which reach the stomach will pass uneventfully through the gastrointestinal tract.1–3 One per cent may require a surgical procedure as 10% can be removed endoscopically.3 The risk of complications including perforation, obstruction and haemorrhage is increased with long sharp metal objects, and may be higher in patients with adhesions due to prior abdominal surgery.1
Objects less than 6 cm in diameter can pass through the pylorus of the stomach and can theoretically cause small bowel obstruction and/or perforation.2 This report describes a 22-year-old male prisoner who previously ingested steel paperclips deliberately straightened out before swallowing which subsequently caused small bowel perforation.
Postingestion, he reported of diffuse central abdominal pain and a conservative approach was taken initially using intravenous antibiotics and fluids. Three days after admission his pain worsened and a CT scan with contrast was performed. This showed paperclip penetration through small bowel loops, with a 2.5 cm collection in the small bowel mesentery deep to these clips.
A laparotomy was performed and multiple straightened paperclips were found extruding through the jejunal wall resulting in two entero–enteral fistulae and free perforation into an abscess cavity (see figures 1 and 2).
Figure 1 .
Straight rigid paperclips and perforated jejunum.
Figure 2 .
Plain radiograph showing multiple locations of paperclips in small bowel—main site of perforation.
The collections were drained and all clips were removed using intraoperative X-ray imaging. The perforated segment of bowel containing the main mass of straightened paperclips was removed with small bowel reanastamosis (minimal peritoneal contamination). He was well enough for discharge 5 days later without any postoperative complications.
Learning points.
Jejunal perforations are relatively rare.
No generalised consensus of how to treat foreign body ingestion greater than 6 cm—paperclips 6.7 cm in length.
Surgery may be indicated where sepsis develops in the presence of persistent foreign bodies in the small bowel.
Acknowledgments
Mr Nigel Scott, Mr Ashok Menon and Dr Emma Watts Royal Preston University Hospital, Radiology Department, Royal Preston University Hospital, Medical Photography Department.
Footnotes
Contributors: Mr Scott operated case. Operators: Mr Scott, AM, IM consent obtained by EW.
Competing interests: None.
Patient consent: Obtained.
Provenance and peer review: Not commissioned; externally peer reviewed.
References
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