DOCTORS AT A Dublin hospital discovered the cause of an elderly patient’s stomach pain stemmed from a 4.25cm-long chicken bone she had swallowed four days prior.
The 81-year-old woman required surgery and has since made a full recovery but doctors are highlighting the case to show the important role of radiological imaging.
According to the case report published by the Irish Medical Journal, the patient attended Connolly Hospital, Blanchardstown complaining of abdominal pain and distension which had been ongoing for four days.
Upon presentation, doctors initially believed the woman’s symptoms were consistent with acute diverticulitis, which is the inflammation of the diverticula (small pouches that stick out of the side of the large intestine colon).
The HSE estimates that 50% of people have diverticula by the time they are 50 years old, and 70% of people have them by the time they are 80.
Diverticulitis carries a risk of causing serious complications, such as the colon rupturing or an infection of the lining of the abdomen (peritonitis).
The case report notes that a CT scan of the woman’s stomach and pelvis showed “a large segment of diverticulosis with a 5cm high attenuation with a 5cm high attenuation linear density projecting through the wall of the mesenteric colon”.
Following this CT scan, the woman was transferred to surgery and underwent a emergency laparotomy.
It was during the operation that surgeons discovered the foreign object was a 4.25cm long chicken bone piercing her colon. There was also inflammation of the lining of the inner wall of the abdomen and the cover of the abdominal organs.
After undergoing a number of procedures, she was discharged to the intensive care unit where she was also treated for an acute kidney infection.
The woman was discharged 18 days after the operation and has since made a good recovery.
Author of the report, Dr Patrick Boland said that patients will often have no recollection of swallowing a foreign object as was the case with this patient.
These factors may lead to an incorrect delayed diagnosis and highlight the important role of radiological imaging.
Plain film radiography can often be of limited value as radiopaque objects may be concealed by fluid or soft tissue. CT has been shown to have a sensitivity of 100% and specificity of 91%,” he said.
The medical report notes that ingestion of a foreign body is a common, often unnoticed, occurrence – observed more frequently in children.
In about 80% of cases, foreign bodies pass through the gastrointestinal tract without issue. The ingested foreign body usually becomes encased in a food bolus and passes safely through the alimentary canal.
It is estimated that 20% of people will require an endoscopic intervention, with surgery required in less than 1% of cases. Perforation is the only absolute indication for surgical intervention, the case report notes.
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