Background: Inadvertent ingestion of foreign bodies can result in potentially life threatening complications such as visceral perforation and may require prompt surgical intervention.
Methods: We report a case of a 75-year-old man who presented to our emergency department in hypovolemic shock. Following initial resuscitation, a CT scan of his abdomen and pelvis was performed showing a 5.5-cm object assumed to be of foreign origin was causing duodenal perforation with associated pneumoperitoneum. Emergency laparotomy revealed a chicken bone perforating through the third part of the duodenum and an omental patch repair of the duodenal defect with extensive washout was performed. Post-operative course was complicated by prolonged post-op stay in critical care unit with pleural effusions, high drain output, hypoalbuminemia and hyperglycemia. In addition, patient developed a large infected intra-abdominal collection requiring multidisciplinary approach with prolonged anti-fungal therapy with intravenous (IV) fluconazole and percutaneous drainage. Cultures of drained fluid revealed Candida albicans. Sensitivities test showed response to Amphotericin B, Caspofungin and Fluconazole.
Results: Majority of ingested foreign objects pass through the gastrointestinal tract without causing complications. In some cases, however, a foreign body can cause obstruction, impaction or perforation prompting emergency surgery to remove the object. Furthermore, co-existing medical issues all increase the risk of developing additional postoperative complications.
Conclusions: Ingested foreign bodies can represent challenging clinical scenarios in a hospital setting. Factors including multiple co-morbidities, shock on admission and postoperative wound and abdominal infections all contribute to prolonged hospital stay and increased mortality.
