Mehdi Trabelsi Mohamed, Neirouz Kammoun, Souhir Nasseh, Souha Bhouri, Mohamed Ali Chaouch, Annouar Oueslati, Mehdi Khalfallah, Ramzi Nouira
Department B of Surgery, Charles Nicolle Hospital, Tunis, Tunisia.
General Surgery Department, Fattouma Bourguiba Hospital, Monastir, Tunisia.
SAGE Open Med Case Rep. 2024 Aug 22;12:2050313X241275802. doi: 10.1177/2050313X241275802. eCollection 2024.
Foreign body (FB) ingestion leading to appendicular perforation, although rare in adults, presents a complex clinical challenge. The clinical presentation may not always be straightforward, necessitating a comprehensive array of diagnostic examinations. In fact, accurate and timely diagnosis is crucial to prevent severe complications. In this report, we present a case where a misleading clinical presentation led to the unexpected discovery of appendicular perforation during surgery, despite initial suspicion of small bowel perforation - a 77-year-old male patient who was edentulous and under follow-up for chronic bronchitis stage IV. He sought medical attention due to a 2-week history of right iliac fossa pain, during which he did not experience vomiting or fever. Upon physical examination, there was a tenderness noted in the sub umbilical region. An abdominal computed tomography (CT) scan was performed, revealing the presence of a dense FB which seems to be a bone located in the last ileal loop. Additionally, the appendix appeared slightly distended. Given the clinical presentation, which strongly indicated acute peritonitis resulting from small bowel perforation, and following consultation with gastroenterologists, it was decided that endoscopic retrieval was not suitable for this case. Therefore, a surgical approach was chosen, involving a midline incision, as laparoscopy was absolutely contraindicated because of patient's respiratory distress. Per-operatively, we identified a clear effusion, and within the wall of the appendix, we discovered a thin, sharp chicken bone that had become lodged, resulting in a phlegmonous and perforated appendix. The 2-cm bone was successfully removed, and an appendectomy was performed. The post-operative period was uneventful, and the patient was discharged on the fourth postoperative day. This case highlights the need for a high index of suspicion for atypical clinical presentations and the ongoing need for research to improve our understanding and management of this rare condition, ultimately enhancing patient outcomes.
异物（FB）摄入导致阑尾穿孔，尽管在成人中很少见，但却带来了复杂的临床挑战。临床表现可能并不总是一目了然，需要进行一系列全面的诊断检查。事实上，准确及时的诊断对于预防严重并发症至关重要。在本报告中，我们介绍了一例病例，尽管最初怀疑是小肠穿孔，但误导性的临床表现导致手术中意外发现阑尾穿孔——一名77岁的男性患者，无牙，因IV期慢性支气管炎正在接受随访。他因右下腹疼痛两周前来就医，在此期间他没有呕吐或发烧。体格检查时，脐下区域有压痛。进行了腹部计算机断层扫描（CT），发现有一个致密的异物，似乎是位于回肠末段的一块骨头。此外，阑尾似乎略有扩张。鉴于临床表现强烈提示小肠穿孔导致急性腹膜炎，在与胃肠病学家会诊后，决定该病例不适合进行内镜取出。因此，选择了手术方法，采用中线切口，由于患者呼吸窘迫，绝对禁忌腹腔镜检查。手术中，我们发现有明显的积液，在阑尾壁内，我们发现了一根细长尖锐的鸡骨头嵌顿在那里，导致阑尾蜂窝织炎并穿孔。成功取出了这根2厘米长的骨头，并进行了阑尾切除术。术后恢复顺利，患者于术后第四天出院。该病例强调了对非典型临床表现要有高度怀疑意识的必要性，以及持续开展研究以增进我们对这种罕见病症的理解和管理，最终改善患者预后的必要性。
