Sierra-Ruiz Melibea, Sáenz-Copete Juan C, Enriquez-Marulanda Alejandro, Ordoñez Carlos A
Universidad ICESI, Facultad de Medicina, Calle18#122.135, Cali, Colombia.
Centro de Investigaciones Clínicas, Carrera 95#18-75, Fundación Clínica Valle del Lili, Cali, Colombia.
Int J Surg Case Rep. 2016;25:184-7. doi: 10.1016/j.ijscr.2016.06.028. Epub 2016 Jun 21.
The ingestion of foreign bodies (FB) is a common problem worldwide and affects all ages; it is, however, particularly important in the pediatric population and in mentally impaired adults. The typical outcome of FB ingestion is good, since the majority of ingested material is passed spontaneously through the gastrointestinal tract. Serious complications can occur, however, including bowel perforation or obstruction and gastrointestinal bleeding, amongst others. Extraluminal migration of ingested foreign bodies is very rare and reported cases so far have shown, more commonly, migration to neck structures, with very few reported cases of migration to the abdomen. To date, there is no reported case of extraluminal migration of ingested FB to the spleen.
A 59-year-old man presented with acute abdominal pain and dyspnea. A CT scan revealed a FB within the spleen, with a ruptured capsule and perisplenic collection. Surgery was performed and a 3cm-long fishbone was extracted, with hemoperitoneum secondary to spleen rupture. The patient was discharged on the third postoperative day with good recovery and without any complications; pneumococcal polysaccharide vaccination was provided.
FB ingestion is a relatively benign condition; however, some serious complications can arise infrequently. The patient reported herein is the first in the literature to present a splenic rupture due to extra luminal migration of an ingested fish bone.
吞食异物在全球都是一个常见问题，各个年龄段都可能发生；不过，这在儿科人群和智力受损的成年人中尤为重要。吞食异物的典型结果较好，因为大多数吞食的物质会自发通过胃肠道排出。然而，也可能发生严重并发症，包括肠穿孔或肠梗阻以及胃肠道出血等。吞食异物的腔外迁移非常罕见，迄今为止报告的病例中，更常见的是迁移至颈部结构，仅有极少数迁移至腹部的病例报告。迄今为止，尚无吞食异物腔外迁移至脾脏的病例报告。
一名59岁男性因急性腹痛和呼吸困难就诊。CT扫描显示脾脏内有一个异物，包膜破裂且脾周有积液。进行了手术，取出了一根3厘米长的鱼骨，因脾破裂导致腹腔积血。患者术后第三天出院，恢复良好，无任何并发症；给予了肺炎球菌多糖疫苗接种。
吞食异物通常是一种相对良性的情况；然而，偶尔也会出现一些严重并发症。本文报告的患者是文献中首例因吞食鱼骨腔外迁移导致脾破裂的病例。
