Ji Dan, Lu Jian-Dong, Zhang Zhi-Guo, Mao Xu-Ping
Department of Radiology, Zhangjiagang Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang 215600, Jiangsu Province, China.
World J Clin Cases. 2023 Mar 6;11(7):1650-1655. doi: 10.12998/wjcc.v11.i7.1650.
Patients with foreign bodies in the digestive tract are often encountered, but complete penetration of a foreign body through the gastrointestinal tract is rare, and the choice of imaging method is very important. Improper selection may lead to missed diagnosis or misdiagnosis.
An 81-year-old man was diagnosed as having a liver malignancy after he took magnetic resonance imaging and positron emission tomography/computed tomography (CT) examinations. The pain improved after the patient accepted gamma knife treatment. However, he was admitted to our hospital 2 mo later due to fever and abdominal pain. This time, he received a contrast-enhanced CT scan, which showed fish-boon-like foreign bodies in the liver with peripheral abscess formation, then he went to the superior hospital for surgery. It lasted for more than 2 mo from the onset of the disease to the surgical treatment. A 43-year-old woman with a 1 mo history of a perianal mass with no obvious pain or discomfort was diagnosed as having an anal fistula with the formation of a local small abscess cavity. Clinical perianal abscess surgery was performed, and fish bone foreign body was found in perianal soft tissue during the operation.
For patients with pain symptoms, the possibility of foreign body perforation should be considered. Magnetic resonance imaging is not comprehensive and that a plain computed tomography scan of the pain area is necessary.
消化道异物患者较为常见,但异物完全穿透胃肠道的情况罕见,且成像方法的选择非常重要。选择不当可能导致漏诊或误诊。
一名81岁男性在接受磁共振成像和正电子发射断层扫描/计算机断层扫描(CT)检查后被诊断为患有肝脏恶性肿瘤。患者接受伽马刀治疗后疼痛有所改善。然而,2个月后他因发热和腹痛入住我院。此次,他接受了增强CT扫描,结果显示肝脏内有鱼骨样异物并伴有外周脓肿形成,随后他前往上级医院接受手术。从发病到手术治疗持续了2个多月。一名43岁女性,有1个月肛周肿物病史,无明显疼痛或不适,被诊断为肛瘘并伴有局部小脓肿腔形成。进行了临床肛周脓肿手术,术中在肛周软组织中发现了鱼骨异物。
对于有疼痛症状的患者,应考虑异物穿孔的可能性。磁共振成像并不全面,对疼痛部位进行CT平扫是必要的。