Pîrvulescu Iulia Cristina, Najm Alfred, Popa Eduard Cristian, Chiotoroiu Alexandru Laurentiu, Cretoiu Sanda Maria, Gaspar Bogdan Severus
Surgery Clinic, Emergency Clinical Hospital, 014461 Bucharest, Romania.
Department of Surgery, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania.
Reports (MDPI). 2023 May 24;6(2):24. doi: 10.3390/reports6020024.
The ingestion of foreign bodies is a common cause for presentation in the emergency department by pediatric, adult, or elderly psychiatric patients. Swallowed foreign bodies sometimes represent a great challenge for surgeons due to the obstruction or perforation of the digestive tube's upper or lower segments. Occasionally, the foreign bodies detected in the lower parts of the digestive tube (colon and rectum) could be introduced through the anal route with the risk of perforation of the rectum or sigmoid colon. In this report, we describe a unique case of a foreign body located in the sigmoid colon, where it arrived due to backstabbing and was retained for 7 years without acute symptoms. The 43-year-old male patient came to the emergency department with pain in the left iliac fossa. Before his presentation, a computerized tomography (CT) scan examination had suggested a foreign body. A surgical approach was decided. The surgery started as an exploratory laparoscopy and was converted to a xiphoid-pubic incision to extract the foreign body (a piece of glass about 8 cm long) through a sigmoid colotomy followed by a double-layer sigmoidorrhaphy. The postoperative evolution of the patient was uneventful. As far as we know, this is the first case of a patient with a foreign glass body positioned in the sigmoid colon that got there by stabbing and not by ingestion or introduced per anum. In conclusion, we suggest that aggressive behavior and abdominal wall penetration by different sharp objects should be considered when foreign bodies are detected in the abdomen.
吞食异物是儿科、成人或老年精神科患者前往急诊科就诊的常见原因。由于消化管上段或下段的梗阻或穿孔，吞食异物有时对外科医生来说是一个巨大的挑战。偶尔，在消化管下部（结肠和直肠）检测到的异物可能通过肛门途径进入，存在直肠或乙状结肠穿孔的风险。在本报告中，我们描述了一例独特的病例，异物位于乙状结肠，是因刺伤进入并留存7年而无急性症状。这位43岁的男性患者因左下腹疼痛来到急诊科。在他就诊前，计算机断层扫描（CT）检查提示有异物。决定采用手术方法。手术开始是 exploratory laparoscopy（此处可能有误，推测可能是“exploratory laparotomy”即剖腹探查术），后改为剑突耻骨联合切口，通过乙状结肠切开术取出异物（一块约8厘米长的玻璃），随后进行双层乙状结肠缝合术。患者术后恢复顺利。据我们所知，这是首例因刺伤而非吞食或经肛门进入导致异物玻璃体位于乙状结肠的病例。总之，我们建议当在腹部检测到异物时，应考虑到不同尖锐物体导致的攻击行为和腹壁穿透情况。
