Intestinal perforation by ingested foreign bodies

Abstract

The aim of our article is to study the incidence, diagnosis, and treatment of bowel perforation by foreign body ingestion. Bowel perforation by foreign body ingestion has been believed to be relatively rare, and most commonly caused by fish bones, chicken bones, and toothpicks. Our clinical experience, however, suggests such perforations may be more common than previously thought, and caused by various other objects as well. Medical records of all patients diagnosed with foreign body-induced intestinal perforation, from the Department of General Surgery at Tonji Hospital, from January 2000 to June 2015, were retrospectively analyzed. A total of 17 men and 8 women suffered intestinal perforations by ingestion of dietary foreign bodies. Among the 25 total patients, 4 ingested foreign bodies intentionally, whereas the other 21 cases were accidental. The foreign bodies were identified by plain X-ray film in 2 patients (2 cases of needles) and by multidetector computed tomography (MDCT) in 11 patients (6 cases of date stones, 3 cases of metallic objects, and 2 cases of bone fragments), thus supporting the correct preoperative diagnosis (13 cases; 52%). The most common location of the perforation was the terminal ileum (n=17). The offending objects were date stones (n=13), bones (n= 7), and metallic objects (n = 5). The most common treatment was removal of the foreign body and closure of the perforation with simple suture (n=22). Ten patients were treated laparoscopically. The present study shows that the most common foreign bodies causing intestinal perforation are date stones and bones. Although about 50% of the foreign bodies could be identified by MDCT, definite diagnosis remained preoperatively difficult. Consequently, because of high misdiagnosis rates, laparoscopy may be the optimal choice for diagnosis and treatment of bowel perforation by foreign bodies.