Shaheen Mohammed F, Barrette Pierre
Department of General Surgery, McGill University Health Centre, Montreal, Canada.
Department of General Surgery, Hôpital du Suroîtl, Salaberry-de-Valleyfield, Canada; Department of General Surgery, Barrie Memorial Hospital, Ormstown, Canada.
Int J Surg Case Rep. 2015;9:12-4. doi: 10.1016/j.ijscr.2015.02.012. Epub 2015 Feb 11.
Gastrointestinal perforation related to foreign body ingestion is uncommon. Surgical interventions aiming at removal of the offending agent and restoration of bowel continuity are sought when perforations occur. Presentation of case A 68 year old male presented with epigastric abdominal pain and anorexia for 2 days. On examination, he was febrile and had localized epigastric tenderness. Laboratory investigations revealed marked leucocytosis with no other abnormalities. Computed tomography revealed the presence of a foreign body penetrating through the full thickness of the gastric wall with its tip lying adjacent to the pancreatic head. Endoscopic trial to extract the foreign body was successfully carried out. The gastric defect was sealed by applying an endoscopic metallic clip.
Gastric perforations secondary to foreign body ingestion usually follow an elusive clinical course and are rarely diagnosed early in its course. Early diagnosis allows for the utilization of minimally invasive management. Unfortunately, Most reported cases were diagnosed after intra-abdominal processes, such as abscesses, have ensued.
This case illustrates the importance of early diagnosis of foreign body related gastrointestinal perforations and emphasizes the role of therapeutic endoscopy.
与异物摄入相关的胃肠道穿孔并不常见。穿孔发生时,需进行手术干预以取出致病因素并恢复肠道连续性。
一名68岁男性因上腹部疼痛和厌食2天前来就诊。检查发现,他发热,上腹部有局限性压痛。实验室检查显示白细胞显著增多,无其他异常。计算机断层扫描显示有一个异物穿透胃壁全层,其尖端位于胰头附近。成功进行了内镜下取出异物的尝试。通过应用内镜金属夹封闭了胃缺损处。
异物摄入继发的胃穿孔通常临床过程隐匿,很少在病程早期被诊断出来。早期诊断有助于采用微创治疗。不幸的是,大多数报道的病例是在腹腔内出现诸如脓肿等病变后才被诊断出来的。
本病例说明了早期诊断异物相关胃肠道穿孔的重要性,并强调了治疗性内镜检查的作用。