Govind Garima, Siriwardana H P Priyantha, Sdralis Elias, Ram Manisha, Lee Peng, Charalabopoulos Alexandros
a Department of General and Upper Gastrointestinal Surgery , Broomfield Hospital, Mid Essex Hospital Services NHS Trust , Chelmsford , UK.
Acta Chir Belg. 2018 Oct;118(5):315-319. doi: 10.1080/00015458.2017.1376432. Epub 2017 Sep 17.
Ingestion of foreign bodies such as fish bone or chicken bone is relatively common in adults; however, resultant transmural migration is extremely rare.
We present a case of a 79-year-old woman with chronic low-grade abdominal pain, worsening over the last 4 days. Computed tomography revealed segmental small bowel wall thickening with chronic inflammation suggestive of Crohn's ileitis and oral steroids were commenced; only later, ingestion of a foreign body was suspected.
At diagnostic laparoscopy, a linear foreign body resembling a wooden splinter was identified. It had partly migrated through the chronically inflamed bowel wall without causing perforation or abdominal contamination. It was removed laparoscopically without an enterotomy or bowel resection. Microscopy revealed non-viable bone, likely fish or chicken bone. The patient made an uneventful recovery and was discharged 3 days later. Herein we emphasise on the differential diagnosis and presentation of chronically ingested foreign bodies, as well as the feature of chronic ileitis with uncomplicated transmural migration of the ingested foreign body that was treated laparoscopically without an enterotomy.
成年人摄入鱼骨或鸡骨等异物较为常见；然而，由此导致的穿壁性迁移极为罕见。
我们报告一例79岁女性病例，该患者有慢性轻度腹痛，在过去4天里病情加重。计算机断层扫描显示节段性小肠壁增厚伴慢性炎症，提示克罗恩病性回肠炎，遂开始使用口服类固醇治疗；只是后来才怀疑有异物摄入。
在诊断性腹腔镜检查中，发现一个类似木刺的线状异物。它已部分穿过慢性炎症的肠壁，但未导致穿孔或腹腔污染。通过腹腔镜将其取出，未进行肠切开术或肠切除术。显微镜检查显示为无活性的骨头，可能是鱼骨或鸡骨。患者恢复顺利，3天后出院。在此我们强调慢性摄入异物的鉴别诊断和表现，以及慢性回肠炎伴摄入异物无并发症的穿壁性迁移的特征，该病例通过腹腔镜治疗，未进行肠切开术。
