Perforation of the Gastrointestinal Tract Secondary to Ingestion of Foreign Bodies
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Ingesting a foreign body (FB) is not an uncommon occurrence. Most pass through the gastrointestinal (GI) tract uneventfully, and perforation is rare. The aim of this study was to report our experience with ingested FB perforations of the GI tract treated surgically at our institution.
A total of 62 consecutive patients who underwent surgery for an ingested FB perforation of the GI tract between 1990 and 2005 were retrospectively reviewed. Three patients with no definite FB demonstrated intraoperatively were included.
The patients had a median age of 58 years, and 37 (60%) were male. Of the 59 FBs recovered, 55 (93%) were toothpicks and dietary FBs such as fish bones or bone fragments. A definitive preoperative history of FB ingestion was obtained for only two patients, and 36 of 52 patients (69%) wore dentures. Altogether, 18 (29%) perforations occurred in the anus or distal rectum, and 44 perforations were intraabdominal, with the most common abdominal site being the distal ileum (39%). Patients with FB perforations in the stomach, duodenum, and large intestine were significantly more likely to be afebrile (P = 0.043), to have chronic symptoms (> 3 days) (P < 0.001), to have a normal total white blood cell count (P < 0.001), and to be asymptomatic or present with an abdominal mass or abscess (P < 0.001) compared to those with FB perforations in the jejunum and ileum.
Ingested FB perforation in the adult population is most commonly secondary to unconscious accidental ingestion and is frequently caused by dietary FBs especially fish bones. A preoperative history of FB ingestion is thus rarely obtained, although wearing dentures is a common risk factor. FB perforations of the stomach, duodenum, and large intestine tend to present with a longer, more innocuous clinical picture than perforations in the jejunum or ileum.
KeywordsForeign Body Plain Radiography Fish Bone Prison Inmate Perianal Abscess
- 1.Ginzburg L, Beller AJ. The clinical manifestations of non-metallic perforating intestinal foreign bodies. Ann Surg 1927;86:918–939Google Scholar
- 4.Madrona AP, Hernandez JA, Prats MC, et al. Intestinal perforation by foreign bodies. Eur J Surg 2000;166:307–309Google Scholar
- 5.Goh BK, Tan YM, Lin SE, et al. Utility of CT scan in the diagnosis of fish bone perforations of the gastrointestinal tract. AJR Am J Roentgenol (in press)Google Scholar
- 7.Maleki M, Evans WE. Foreign-body perforation of the intestinal tract: report of 12 cases and review of the literature. Arch Surg 1970;101:474–477Google Scholar
- 10.Ward McQuaid JN. Perforation of the intestine by swallowed foreign body. Br J Surg 1952;37:349–351Google Scholar
- 12.Henderson FF, Gaston EA. Ingested foreign body in the gastrointestinal tract. Arch Surg 1938;36:66–95Google Scholar
- 16.Carp L. Foreign bodies in the intestine. Ann Surg 1927;85:575–591Google Scholar
- 18.Lambert A. Abscess of the liver of unusual origin. NY Med J 1898;February:177–178Google Scholar
- 20.Ngan JH, Fok PJ, Lai EC, et al. A prospective study on fish bone ingestion: experience of 358 patients. Ann Surg 1989;211:459–462Google Scholar