Rare case of Appendicitis due to needle ingestion

Dr Francisco Tustumi at FMUSP, São Paulo, SP, Brazil and colleagues have reported an unusual and rare case of appendicitis and appendix perforation caused by needle ingestion.The case has been published in the International Journal of Surgery Case Reports.

This is an unusual case of appendicitis caused by accidental ingestion of a needle which was treated with Laparoscopic appendectomy.

Acute appendicitis due foreign body ingestion is extremely rare. Laparoscopy was the chosen access once it was more suitable for inventory of the gastrointestinal tract and help avoiding harm of the medical team during hand maneuvers of open access surgery.

According to the history a 64 year-old white woman, seamstress, was admitted in a urgent care unit complaining of 24 h of right lower quadrant abdominal pain associated with constipation, anorexia, mild fever, chills and malaise. No significant past medical history was mentioned.

Vital signs assessment revealed normal blood pressure, normal heartbeat frequency with 68 beats/min, non-elevated respiratory rate with 16 breaths/min of respiratory rate and 36 °C body temperature. No relevant drug, family, or psychosocial history. Patient's physical examination revealed mild tenderness during palpation of right lower part of the abdomen, however not suggesting clinical peritonitis.

Laboratory results showed Hemoglobin: 14.5 g/dL, Hematocrit: 44.7%, Leukocytes: 11.5 × 103/μL, Platelets: 254 × 103/μL. Amylase, lipase, and liver enzymes were within normal limits.

Plain radiograph revealed a metal density foreign body in the right lower quadrant (see Fig. 1). Computed tomography (CT) showed foreign body within the appendix lumen

The patient was advised a Diagnostic Laparoscopic procedure which revealed a perforated appendix and inflammation around it (appendicitis) due to needle perforation. Using the same Laparoscopic procedure appendectomy were done and foreign body was removed.

The authors concluded that Foreign body ingestion should be remembered as an unusual differential diagnosis of acute appendicitis. Acute appendicitis due foreign body ingestion is extremely rare and laparoscopy was the chosen access compared to open access surgery.

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https://www.sciencedirect.com/science/article/pii/S2210261220304120