AN INCIDENTAL CASE OF - HOLLOW VISCUS PERFORATION SECONDARY TO FOREIGN BODY IMPACTION

Abstract

Introduction:
Ingestion of foreign bodies is a common occurrence, with the majority passing through the gastrointestinal tract without issue. However, in rare cases, foreign bodies can lead to bowel perforation, presenting challenges in preoperative diagnosis due to various factors such as patients' inability to recall ingestion and the difficulty of identifying certain foreign bodies on imaging scans.

Presentation of the Case:
A 58-year-old male with a known history of Bronchial Asthma presented to JSS Hospital with abdominal pain, constipation, and distension. Upon examination, rigidity and diffuse tenderness were noted. X-ray and ultrasound findings suggested hollow viscus perforation, leading to a working diagnosis of emergency exploratory laparotomy.

Discussion:
Foreign body ingestion is frequently observed in certain populations and can lead to gastrointestinal perforation, with the terminal ileum being the most common site. Diagnosis of silent perforations is often incidental, with imaging modalities such as CT scans playing a crucial role. Management of asymptomatic abdominal foreign bodies presents challenges and requires individualized approaches. Clinical presentations vary widely, with some cases being asymptomatic, further complicating diagnosis without a definitive history of foreign body ingestion.

Conclusion:
Gastrointestinal perforation resulting from unintentional ingestion, particularly of dietary items like fish bones, is prevalent in the adult population. Patients often do not recall swallowing foreign bodies prior to surgery, with denture wearers being at higher risk. Clinical presentation varies depending on the perforation site, with perforations in the jejunum or ileum typically having a more severe clinical course compared to other sites. Early recognition and management are essential in mitigating complications associated with gastrointestinal perforation from foreign body ingestion.