What Happens if Human Swallows Small Beef Bone Fragment in Meat
World J Clin Cases. 2013 October 16; 1(7): 212–216.
Ingested bone fragment in the bowel: Two cases and a review of the literature
Received 2013 May ii; Revised 2013 Jul 29; Accepted 2013 Aug 12.
Abstract
Generally, ingested foreign bodies are excreted from the digestive tract without whatsoever complications or morbidity. In adults, ingestion of foreign bodies frequently occurs in alcoholics and elderly individuals with dentures. The virtually commonly ingested foreign bodies are food stuffs or their parts, such as fish bones or fragments of os and phytobezoars. Sharp foreign bodies like fish and chicken bones can lead to intestinal perforation and peritonitis. We report herein two cases, one of bowel perforation and another of anal impaction, both caused by ingested bone fragments. Complications due to ingested bone fragments are non mutual and preoperative diagnosis remains a challenge and therefore information technology must be considered in susceptible cases.
Keywords: Bone fragment, Bowel perforation, Anal pain
Cadre tip: The ingested bone fragment may crusade bowel perforation at whatsoever site from the jejunum to anal margin, obstruction and fistula germination. An experienced clinician should suspect such conditions in the presence of some predisposing factors, such every bit rapid eating and the apply of dentures in the elderly, and should consider various surgical options. We study herein two cases, ane of bowel perforation and another of anal impaction, both caused by ingested bone fragments. Complications due to ingested bone fragments are not common and preoperative diagnosis remains a claiming and therefore information technology must exist considered in susceptible cases.
INTRODUCTION
The majority of ingested foreign bodies (IFB) are excreted from the digestive tract without whatever complications or morbidity; however, occasionally they may lead to serious clinical problems, such equally obstruction, perforation or bleeding[1-iii]. Although IFB are a common problem in children, they are infrequently encountered in adults merely are seen in elderly people wearing dentures, alcoholics and/or patients with learning difficulties[four]. IFB, such as chicken bones, fish bones, toothpicks and dentures, rarely require surgical intervention (5%). Patients are not ordinarily aware of the IFB which is usually detected either during laparotomy or at the fourth dimension of pathology test of the surgical specimen[5]. Less than ane% of IFB, particularly large, sharp and/or pointed objects, cause bowel perforation. Perforation usually occurs at the narrowest parts of the bowel, either at the ileocecal valve or at the rectosigmoid junction[vi]. In the literature, there are reports of ingested os causing intestinal perforation, enterovesical fistula and perianal abscesses[iv-vii].
We report herein two patients who presented with different complications caused by an ingested bone fragment; we besides review the existing literature on IFB in the gastrointestinal (GI) tract.
Example Written report
Example 1
An 87-year-former woman was admitted to the emergency section with complaints of intestinal hurting and airsickness for 2 d. Her past medical history included chronic obstructive pulmonary illness, cardiac failure and renal failure. On physical examination, she was witting and alert, with a mild pyrexia. Abdominal examination revealed generalized rebound tenderness. Her white blood prison cell count, BUN and creatinine levels were out of the normal range; 13.500/μL, 79.5 mg/dL and 2.5 mg/dL respectively. Autonomously from free intra-abdominal fluid, no other abnormality was detected on intestinal 10-ray, abdominal ultrasound (US) and computed tomography (CT). As the reason of the acute abdominal pain was non clear, a laparotomy was performed. At laparotomy, 500 cc of a purulent fluid collection in the right paracolic region and a perforation caused by a protruding sharp-pointed bone fragment, 15 cm proximal of the ileocecal valve, were noted (Figure 1). Partial ileal resection and end ileostomy were performed. She was discharged on the postoperative 8th mean solar day. Ileostomy closure was successfully performed after three months. After surgery, her intestinal CT browse was re-evaluated by the radiologists and a lesion with bone density was identified at the concluding ileal region (Effigy two).
A sharp-pointed os fragment perforated the ileum and protruded from this expanse. The arrow shows precipitous pointed bone fragment.
There is a lesion in bone density at the right hypogastric region on the abdominal computed tomography (arrow).
Case 2
A 27-year-old female was admitted to the general surgery outpatient clinic complaining of severe anal pain for 3 d. Previous medical history revealed no significant pathology. Anal inspection in the knee-breast position was normal; at anal digital examination a difficult, flat object lodged in the anal culvert four cm above the anal margin was identified. Abdominal CT confirmed the presence of the strange body in bone density. In the operation room under sedation and analgesia, a 2 cm bone fragment that was lodged at the lateral rectal wall was removed by a Kelly clamp with anoscopy. The patient was discharged six h after the intervention.
DISCUSSION
Accidentally ingested foreign bodies are a common problem. Most of the IFB pass uneventfully through the gastrointestinal tract and are excreted in the stool inside 1 wk[4]. Strange trunk ingestion generally occurs in babyhood simply may too exist seen in adults. In adults, IFB are usually seen in alcoholics, elderly individuals with dentures, drug abusers, prisoners, individuals with mental disorders or learning difficulties, people with fast eating habits and workers such equally carpenters and dressmakers who tend to hold pocket-sized sharp objects in their mouths[iv,8]. Elderly people may take problem using dentures and as the sense of feeling in the palate is decreased, they may become prone to FB ingestion. Generally patients exercise non recall ingesting a foreign trunk and this is unremarkably detected on radiological imaging studies, during surgery or in the pathological examination of the surgical specimens[5,7]. Both patients presented herein did not recall any FB ingestion. Although the kickoff case was an elderly private who wore dentures and had comorbidities, the 2nd case was a immature woman with no prior mental or physical disorders. Nonetheless, she somewhen admitted to beingness a fast eater.
The American Order for Gastrointestinal Endoscopy classifies IFB equally: (one) food bolus impactions, usually meat; (2) blunt objects, such as coins; (3) long objects, longer than 6-x cm such every bit toothpicks; (iv) abrupt-pointed objects, such every bit fish bones or pocket-sized bones; (5) disk batteries; and (vi) narcotic packets, wrapped in plastic or latex. The types of IFB vary co-ordinate to regional differences and feeding habits. For example, fish bone ingestion is more common in eastern countries while meat bolus impactions are mostly seen in western countries[four,9]. The most mutual IFB are nutrient stuffs or their parts, such as fish bones, bone fragments or vegetable bezoars and toothpicks[4]. Although by and large the ingested bones are digested or uneventfully pass through the gastrointestinal tract within i wk, complications such as impaction, perforation or obstruction may rarely occur[7,10-xiii]. Gastrointestinal perforation occurs in less than 1% of all patients. The possibility of perforation is associated with the length and sharpness of the swallowed object[fourteen]. Ingested sharp bones, fish and chicken basic can lead to intestinal perforation and peritonitis[xv]. Goh et al[16] state that most of the foreign bodies causing gastrointestinal tract perforation were of a food origin, such as fish basic, craven bones, bone fragments or shells. Some other study on IFB institute that a fish bone was the most frequently encountered foreign trunk causing GI tract perforation[17]. In some cultures or religions, people adopt to consume all parts of the fish and thus fish bone ingestion and related complications are common in these populations[18]. GI perforations caused by a chicken bone are less frequently reported. Besides, unlike GI complications were defined every bit caused by poultry bones, duck bones, rabbit bones and meat bone fragments in the literature[nineteen,twenty].
Although bowel perforations may occur at whatsoever part of the intestinal tract, the most common site is at an acute angulation or physiological narrowing, such as the ileocecal region and rectosigmoid junction[seven,11]. It is reported that the ileum was the site of perforation in 83% of cases[21]. Goh et al[xvi] recorded the most mutual site of intra abdominal perforation equally the terminal ileum in 38.half dozen%. Perforation of the jejunum is less frequent and its incidence is approximately 14.3%[four]. Predisposing factors for perforation or other complications are bowel disease, adhesions, diverticular disease, inflammatory bowel illness, bowel tumors, abdominal wall hernias and a blind loop of bowel[16]. Glasson et al[11] reported a example with perforated sigmoid diverticulum caused by a chicken bone. Akhtar et al[12] reported 3 cases with bowel perforation caused by chicken bones, 2 cases had a hernia and the other case had diverticulitis. In their case study and review of literature, McGregor et al[xiii] presented a case in whom clinical diagnosis of previously undiagnosed carcinoma was established based on colonic perforation resulting from ingested chicken/poultry bone and they besides reported three such cases in the literature.
There were no abdominal or abdominal disorders in our cases but they said they experienced constipation from time to fourth dimension. Bowel perforations can present with different clinical manifestations, such as intra abdominal abscesses, anal fistula or rectal abscess, coloenteric, colovesical or rectocutaneous fistulas, and acute belly. A very interesting clinical presentation reported in the literature is an aortocolic fistula[8,22-24]. Although generally anal or rectal FB engage transanally and are possible causes of anal pain, ingested fish bone has been reported to lead to perianal abscesses, anal fistulae and severe anal pain. Adufull[ten] reported that ingested chicken basic and fragments of meat os tin besides cause anal hurting, abscess formation and anal fistula[10]. Cash et al[8] also reported anorectal abscess and fistula acquired past ingested chicken bones; they stated that a partially closed anal sphincter against rectal contractions might lead to these disorders.
IFB usually nowadays with non-specific symptoms and different clinical symptoms may occur in patients. Intestinal hurting is the nigh mutual complaint (95%), followed past fever (81%) and localized peritonitis (39%). The other symptoms that may occur are nausea, vomiting, hematochezia and melena. Bowel perforation and acute surgical abdomen can pb to misdiagnosis with other weather causing surgical abdominal diseases, such as acute appendicitis, diverticulitis or perforated peptic ulcer[7,25]. The most mutual preoperative diagnosis is acute belly of uncertain origin[xviii]. Gastric, duodenal or colonic perforations can present as more chronic events, such as abdominal mass or abscess[xiv]. Normally physicians cannot plant a preoperative diagnosis equally the patient cannot recall a foreign body ingestion.
Our first instance presented with acute abdominal pain and the 2nd with severe anal pain, particularly during defecation. By and large, no specific paradigm is detected past imaging methods. Free abdominal gas due to pneumoperitoneum, intestinal fluid drove, gas-fluid levels due to bowel obstruction, or a chicken os prototype facilitates the preoperative diagnosis[15].
Gratis gas is rarely detected on intestinal Ten-rays; it was present in only 20% of cases with perforation[vii]. According to the studies, the caste of radiopacity of ingested fish bones varies co-ordinate to the species of the fish[16]. A prospective study of 358 patients with fish bone ingestion revealed that a plain radiography had a sensitivity of only 32%[26]. Ingested fish bones are overlooked on evidently films every bit they are minimally radiopaque and adjacent inflammatory tissue or fluids interfere with the image of the fish bone[22].
Ultrasound can detect even non radiopaque FB, such equally fish bones and toothpicks, based on their high reflectivity and variable posterior shadowing. At that place are reported cases of ingested FB defined by US[17]. Intra abdominal fluid and side by side tissue changes can be seen using US.
Abdominal CT scan can detect even more details, such as intestinal obstruction, pneumoperitoneum, a thickened intestinal wall or strange body[16]. Goh et al[17] reported, in their study of seven patients with fish bone perforations, that a correct diagnosis was made in 5 of the vii original radiology reports. Withal, on retrospective review of the scans, the fish bones could exist identified in all cases, typically appearing every bit a linear calcified lesion surrounded by an expanse of inflammation.
In this report, the intestinal 10-ray of the first case was evaluated as normal, ultrasound and CT browse just showed intra abdominal fluid and therefore the preoperative evaluation was non diagnostic. However, in the postoperative evaluation of the CT browse, the radiologists detected a radiopaque lesion at the terminal ileum. In the 2d case, no X-ray test was performed as X-ray examination was insufficient in revealing non radiopaque FBs and other intra abdominal complications. We preferred only CT scan for imaging methods. The CT scan revealed no pathology except a os density lesion in the rectum.
Simply i% of the complicated ingested FB in the alimentary canal requires a surgical operation; ten% to 20% of them are successfully removed past non operative methods such as endoscopy[xi]. If the foreign body is at the anorectal region, it is easily removed via proctosigmoidoscopy or digitally[27]. Watanabe et al[28] detected a fish bone stuck in the sigmoid colon wall past sigmoidoscopy and removed it with a sigmoidoscopy snare[28].
In recent years, laparoscopy has been used for intraperitoneal and intraluminal strange body removal with success. Laparoscopy is less invasive than laparotomy and thus it can be a expert choice for FB removal[29]. Hur et al[15] reported 2 cases of peritonitis caused by sharp bones perforating the intestinal tract and the bones were successfully removed by laparoscopy. Surgery treatment is based on removal of FB and peritoneal lavage. The appropriate surgical intervention is decided co-ordinate to the anatomical location of the perforation or other clinical pathological findings, such as primary suture of a perforated bowel segment, bowel resection and a Hartman process. Antibody handling should besides be added to the surgical treatment[7,27]. Generally, surgeons prefer resection; the utilise of primary sutures is rare in the literature. In the presence of whatever accompanied surgical disorders, such every bit abdominal wall hernias, diverticulitis or sigmoid tumor, advisable treatment is performed[13,21].
When a perianal fistula or abscess or a colovesical fistula is caused by a FB, after removal of the FB, abscess may exist drained and the fistula can be operated on. Aduful[ten] also reported 2 cases of swallowed bones that caused anal pain and anal fistula.
Our offset case was an astute surgical abdomen; she was an elderly patient with cardiac, respiratory and renal disorders. The anesthesiologists evaluated the patient using the American Society of Anesthesiologists (ASA) classification, ASA-4, and thus a laparotomy was preferred, which was a fast surgery and a well-known method. Laparoscopy was not preferred because of technical weather. During the operation, ileum perforation by a bone fragment and intra abdominal diffuse purulent fluid was observed. The case was non suitable for primary repair, we considered anastomosis may pose a risk and therefore resection and terminate ileostomy was performed. In the 2nd case, as a FB was suspected and a careful rectoscopic examination under sedation was washed, the impacted bone fragment was seen and removed.
Complications due to ingested os fragments are not common and preoperative diagnosis remains a challenge. The patient'south medical history can exist misleading and the clinical symptoms are not specific. They tin present with different clinical manifestations in the bowel. The ingested os fragment may cause bowel perforation at any site from the jejunum to anal margin, obstruction and fistula formation. An experienced clinician should doubtable such conditions in the presence of some predisposing factors, such every bit rapid eating and the use of dentures in the elderly, and should consider various surgical options.
Footnotes
P- Reviewers Ingle SB, Jia HG, Koulaouzidis A, Yen HH S- Editor Zhai HH L- Editor Roemmele A Eastward- Editor Wang CH
References
one. Paul RI, Christoffel KK, Binns HJ, Jaffe DM. Foreign trunk ingestions in children: risk of complication varies with site of initial health care contact. Pediatric Practice Research Group. Pediatrics. 1993;91:121–127. [PubMed] [Google Scholar]
2. Hashmonai M, Kaufman T, Schramek A. Silent perforations of the stomach and duodenum past needles. Arch Surg. 1978;113:1406–1409. [PubMed] [Google Scholar]
iii. Cheng Westward, Tam PK. Foreign-torso ingestion in children: experience with i,265 cases. J Pediatr Surg. 1999;34:1472–1476. [PubMed] [Google Scholar]
4. Rodríguez-Hermosa JI, Codina-Cazador A, Sirvent JM, Martín A, Gironès J, Garsot E. Surgically treated perforations of the gastrointestinal tract acquired by ingested foreign bodies. Colorectal Dis. 2008;10:701–707. [PubMed] [Google Scholar]
5. Yilmaz M, Akbulut S, Ozdemir F, Gozeneli O, Baskiran A, Yilmaz S. A swallowed dental prosthesis causing duodenal obstacle in a patient with schizophrenia: Description of a new technique. Int J Surg Case Rep. 2012;iii:308–310. [PMC free article] [PubMed] [Google Scholar]
6. Kornprat P, Langner C, Mohadjer D, J Mischinger H. Craven-bone perforation of a sigmoid colon diverticulum into the right groin and subsequent phlegmonous inflammation of the abdominal wall. Wien Klin Wochenschr. 2009;121:220–222. [PubMed] [Google Scholar]
7. Joglekar Southward, Rajput I, Kamat S, Downey S. Sigmoid perforation acquired past an ingested chicken bone presenting equally right iliac fossa pain mimicking appendicitis: a case study. J Med Case Rep. 2009;3:7385. [PMC free article] [PubMed] [Google Scholar]
8. Greenbacks DJ, Sadat MM, Abu-Own AS. Anorectal abscess and fistula acquired by an ingested chicken os. Am J Gastroenterol. 2004;99:1617–1618. [PubMed] [Google Scholar]
nine. Guideline for the management of ingested foreign bodies. American Society for Gastrointestinal Endoscopy. Gastrointest Endosc. 1995;42:622–625. [PubMed] [Google Scholar]
11. Glasson R, Haghighi KS, Richardson G. Craven os perforation of a sigmoid diverticulum. ANZ J Surg. 2002;72:448–449. [PubMed] [Google Scholar]
12. Akhtar S, McElvanna N, Gardiner KR, Irwin ST. Bowel perforation acquired by swallowed chicken bones--a case series. Ulster Med J. 2007;76:37–38. [PMC free article] [PubMed] [Google Scholar]
13. McGregor DH, Liu X, Ulusarac O, Ponnuru KD, Schnepp SL. Colonic perforation resulting from ingested chicken os revealing previously undiagnosed colonic adenocarcinoma: report of a case and review of literature. World J Surg Oncol. 2011;ix:24. [PMC free article] [PubMed] [Google Scholar]
14. Hoxha FT, Hashani SI, Komoni DS, Gashi-Luci LH, Kurshumliu FI, Hashimi MSh, Krasniqi Equally. Acute belly caused past ingested chicken wishbone: a case report. Cases J. 2009;2:64. [PMC gratis article] [PubMed] [Google Scholar]
15. Hur H, Song KY, Jung SE, Jeon HM, Park CH. Laparoscopic removal of bone fragment causing localized peritonitis by intestinal perforation: a written report of two cases. Surg Laparosc Endosc Percutan Tech. 2009;nineteen:e241–e243. [PubMed] [Google Scholar]
16. Goh BK, Chow PK, Quah HM, Ong HS, Eu KW, Ooi LL, Wong WK. Perforation of the gastrointestinal tract secondary to ingestion of foreign bodies. Earth J Surg. 2006;30:372–377. [PubMed] [Google Scholar]
17. Goh BK, Tan YM, Lin SE, Grub PK, Cheah FK, Ooi LL, Wong WK. CT in the preoperative diagnosis of fish bone perforation of the gastrointestinal tract. AJR Am J Roentgenol. 2006;187:710–714. [PubMed] [Google Scholar]
18. Yamamoto T, Hirohashi Chiliad, Iwasaki H, Kubo S, Tanaka Y, Yamasaki M, Koh M, Uenishi T, Ogawa M, Sakabe K, et al. Pseudotumor of the omentum with a fishbone nucleus. J Gastroenterol Hepatol. 2007;22:597–600. [PubMed] [Google Scholar]
19. WARD-McQUAID JN. Perforation of the intestine of intestine by swallowed strange bodies, with a report of two cases of perforation by rabbit basic. Br J Surg. 1952;39:349–351. [PubMed] [Google Scholar]
20. Yıldız F, Terzi A, Coban S, Cece H, Uzunkoy A. Perforation of the terminal ileum secondary to ingestion of duck bone. Acta Medica Academica. 2009;three:35–38. [Google Scholar]
21. Singh RP, Gardner JA. Perforation of the sigmoid colon by swallowed chicken bone: instance reports and review of literature. Int Surg. 1981;66:181–183. [PubMed] [Google Scholar]
22. Drakonaki E, Chatzioannou Thou, Spiridakis One thousand, Panagiotakis G. Acute abdomen caused past a small bowel perforation due to a clinically unsuspected fish bone. Diagn Interv Radiol. 2011;17:160–162. [PubMed] [Google Scholar]
23. Caes F, Vierendeels T, Welch Westward, Willems G. Aortocolic fistula caused by an ingested chicken bone. Surgery. 1988;103:481–483. [PubMed] [Google Scholar]
24. Khan MS, Bryson C, O'Brien A, Mackle EJ. Colovesical fistula caused past chronic chicken os perforation. Ir J Med Sci. 1996;165:51–52. [PubMed] [Google Scholar]
25. Cho HJ, Kim SJ, Lee SW, Moon SW, Park JH. Pseudotumor of the omentum associated with migration of the ingested crab-leg. J Korean Med Sci. 2012;27:569–571. [PMC free article] [PubMed] [Google Scholar]
26. Ngan JH, Fok PJ, Lai EC, Branicki FJ, Wong J. A prospective report on fish bone ingestion. Experience of 358 patients. Ann Surg. 1990;211:459–462. [PMC free article] [PubMed] [Google Scholar]
28. Watanabe M, Kou T, Nishikawa Y, Sakuma Y, Kumagai N, Oda Y, Kato Y, Kudo Y, Yamauchi A, Sugiura Y, et al. Perforation of the sigmoid colon by an ingested fish os. Intern Med. 2010;49:1041–1042. [PubMed] [Google Scholar]
29. Mentum EH, Hazzan D, Herron DM, Salky B. Laparoscopic retrieval of intraabdominal foreign bodies. Surg Endosc. 2007;21:1457. [PubMed] [Google Scholar]
Articles from Globe Journal of Clinical Cases are provided here courtesy of Baishideng Publishing Group Inc
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3856294/
0 Response to "What Happens if Human Swallows Small Beef Bone Fragment in Meat"
Post a Comment