Gou Ze-Hui, Peng Yulan, Yang Kun
Department of Ultrasound Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.
Medicine (Baltimore). 2018 Apr;97(16):e0427. doi: 10.1097/MD.0000000000010427.
Sharp foreign bodies such as toothpicks or chicken bones can lead to intestinal perforation. Small intestinal perforation secondary to foreign body ingestion is usually manifested as an acute abdomen without a history of trauma. Here we describe the diagnosis and treatment of a case of small bowel perforation caused by an ingested pill and its outer packing.
An 84 years old male patient complained of right lower abdominal pain for 4 days and the pain was becoming progressively worse.
The patient, who has Alzheimer's disease, mistakenly took the pill (oxiracetam) without removing the outer packaging. This resulted in perforation of the small intestine.
During the ultrasound examination, the scanning physician discovered that the abnormal sonographic findings present could not be explained by the leading diagnosis of perforation of the small intestine at the time. This led the physician to suspect small bowel perforation secondary to a foreign body. The subsequent computerized tomography (CT) examination further confirmed the ultrasound findings.
Emergency laparotomy was performed and the foreign body was removed. After the surgical procedure, the patient resumed anti-inflammatory treatment (Cefoxitin sodium 2000mg tid) and rehydration therapy (Sodium Chloride Solution 100mL tid).
Because ingestion of foreign bodies of this type is relatively rare, when patients cannot provide an accurate history, diagnosis can be quite difficult. In this paper, the imaging features associated with intestinal perforation secondary to foreign body ingestion on ultrasound and CT are described. This series of events demonstrate how imaging findings can guide and alter a clinician's decision-making.
牙签或鸡骨头等尖锐异物可导致肠穿孔。因吞食异物继发的小肠穿孔通常表现为急腹症，且无外伤史。在此，我们描述一例因吞食药丸及其外包装导致小肠穿孔的病例的诊断和治疗。
一名84岁男性患者主诉右下腹痛4天，且疼痛逐渐加重。
该患有阿尔茨海默病的患者误服了未去除外包装的药丸（奥拉西坦），导致小肠穿孔。
在超声检查过程中，扫描医生发现当时小肠穿孔的主要诊断无法解释现有的异常超声表现。这使医生怀疑是异物继发的小肠穿孔。随后的计算机断层扫描（CT）检查进一步证实了超声检查结果。
进行了急诊剖腹手术并取出异物。手术后，患者继续进行抗炎治疗（头孢西丁钠2000mg，每日三次）和补液治疗（氯化钠溶液100mL，每日三次）。
由于此类异物吞食相对罕见，当患者无法提供准确病史时，诊断可能相当困难。本文描述了超声和CT上与异物吞食继发肠穿孔相关的影像学特征。这一系列事件展示了影像学表现如何指导并改变临床医生的决策。
