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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 24  |  Issue : 1  |  Page : 51-52

Plastic foreign body appearing as radiopaque in a child: An interesting case


1 Department of Pediatric Surgery, SMS Medical College, Jaipur, Rajasthan, India
2 Department of Obstetrics and Gynecology, SMS Medical College, Jaipur, Rajasthan, India

Date of Web Publication14-Mar-2019

Correspondence Address:
Dr. Aditya Pratap Singh
Near The Mali Hostel, Main Bali Road, Falna, Dist-Pali, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmgims.jmgims_47_18

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  Abstract 


Accidental and unnoticed ingestion of foreign bodies (FBs) is not very uncommon. Most of such FBs pass through the gastrointestinal tract uneventfully and only on rare instances cause obstruction or perforation. We present here a case of unnoticed ingested plastic FB in an 11-month-old male child. The baby was presented to us with the complaint of acute intestinal obstruction. The plastic FB appeared as a radiopaque ring in the plain erect abdominal X-ray. The patient was managed by only sodium phosphate enema, which expelled the FB out through the anus.

Keywords: Enema, foreign body, plastic, radiopaque


How to cite this article:
Singh AP, Tanger R, Gupta AK, Pardeshi R. Plastic foreign body appearing as radiopaque in a child: An interesting case. J Mahatma Gandhi Inst Med Sci 2019;24:51-2

How to cite this URL:
Singh AP, Tanger R, Gupta AK, Pardeshi R. Plastic foreign body appearing as radiopaque in a child: An interesting case. J Mahatma Gandhi Inst Med Sci [serial online] 2019 [cited 2019 Mar 25];24:51-2. Available from: http://www.jmgims.co.in/text.asp?2019/24/1/51/254132




  Introduction Top


Foreign body (FB) ingestion is common in children and psychiatric patients and uncommon in normal adults. Accidental ingestion is the most common cause in children. The majority of ingested FBs that reach the stomach pass uneventfully through the gastrointestinal tract, and the majority of cases occur in children aged between 6 months and 3 years.[1],[2] Coins, marbles, pins, keys, toys, button batteries, stones, nails, and rings are some of the common FBs ingested by children. We present here a case of radiopaque plastic FB in an 11-month-old male child with acute intestinal obstruction.


  Case Report Top


An 11-month-old male child presented to us with the complaints of bilious vomiting and pain abdomen for the last 5 days. There was no history of any FB ingestion. On local examination, the abdomen was soft but with mild distension. The baby also had not passed motion for the last 4 days. Routine blood investigations were within normal limits including complete blood counts, renal function test, and serum electrolytes. X-ray abdomen erect showed multiple air–fluid levels with prominent jejunal and ileal loops [Figure 1]a. There was also a radiopaque ring-like structure in the X-ray abdomen [Figure 1]a. Ultrasonography abdomen showed acute intestinal obstruction with dilated bowel loops. We administered sodium phosphate enema in view of the radiopaque FB lying in the colon [Figure 1]b. The baby passed motion with a plastic FB in the stool [Figure 2]. The patient was treated conservatively and discharged after 3 days.
Figure 1: (a) X-ray abdomen erect showing multiple air–fluid levels with prominent jejunal and ileal loops with a radiopaque ring-like structure, (b) X-ray after enema

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Figure 2: Expelled-out ball-like plastic foreign body through the anus after enema

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  Discussion Top


Majority of the FBs proceed through the gut, with most objects passing spontaneously through the anus without complication once they pass the gastroesophageal junction.[3],[4] However, objects with sharp edges or points such as pins, needles, tacks, razor blades, pieces of glass, or open safety pins may cause erosion or perforation at any level of the gastrointestinal tract.

Plastic clip ingestion such as those used for bread packages has been noted to grip various portions of the bowel mucosa, producing inflammation and ulceration and eventually leading to severe complications such as perforation, obstruction, intussusception fistula formation, abdominal abscess formation, and death. Unfortunately, these clips are not opaque on radiographs and are difficult to detect.

Metallic FBs are radiopaque and can be easily detected on plain radiography.[3] Plastics are nonradiopaque on plain radiography. They may become encrusted with mineral or bile salts and are thereby rendered opaque.[5] It was also the reason in our case. The FB was of plastic ball-like structure, and it was encrusted with mineral or bile salts. It led to the appearance of a radiopaque ring-like structure in the plain radiography.

Imaging modalities other than X-ray for detection and characterization of ingested FBs are rarely used in clinical and research settings. Ultrasonographic techniques show promising results and are radiation free,[6] but they require a skilled technician at the point of care and specialized equipment. Other modalities including contrast X-ray, computed tomography,[7] and magnetic resonance imaging (MRI) may be helpful in specific circumstances, but involve increased radiation exposure (except MRI), cost, and complexity.

Patients who had swallowed foreign objects should be carefully observed in terms of abdominal pain and distension. During observation period, a daily radiograph should be obtained, and the patient should be checked for signs of peritonitis or gastrointestinal bleeding. Stools should also be examined for the FB in the follow-up. In case of gastrointestinal hemorrhage or peritonitis, surgical exploration and removal of the object is necessary.


  Conclusion Top


The present case report intends to draw the attention toward the possibility of intestinal obstruction by a single plastic FB. A high index of suspicion is needed as this FB is not even radiopaque and cannot be picked up in X-ray investigations. Furthermore, with increasing usage of such plastic materials, there is increased chance of such incidents.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgment

The author would like to thank Dr. Neelam Dogra, Senior Professor, Department of Anaesthesia, SMS Medical College, Jaipur, Rajasthan India.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
van As AB, du Toit N, Wallis L, Stool D, Chen X, Rode H, et al. The South African experience with ingestion injury in children. Int J Pediatr Otorhinolaryngol 2003;67 Suppl 1:S175-8.  Back to cited text no. 1
    
2.
Chung JH, Kim JS, Song YT. Small bowel complication caused by magnetic foreign body ingestion of children: Two case reports. J Pediatr Surg 2003;38:1548-50.  Back to cited text no. 2
    
3.
Velitchkov NG, Grigorov GI, Losanoff JE, Kjossev KT. Ingested foreign bodies of the gastrointestinal tract: Retrospective analysis of 542 cases. World J Surg 1996;20:1001-5.  Back to cited text no. 3
    
4.
Cash DJ, Sadat MM, Abu-Own AS. Anorectal abscess and fistula caused by an ingested chicken bone. Am J Gastroenterol 2004;99:1617-8.  Back to cited text no. 4
    
5.
Hunter TB, Taljanovic MS. Foreign bodies. Radiographics 2003;23:731-57.  Back to cited text no. 5
    
6.
Piotto L, Gent R, Kirby CP, Morris LL. Preoperative use of ultrasonography to localize an ingested foreign body. Pediatr Radiol 2009;39:299-301.  Back to cited text no. 6
    
7.
Luk WH, Fan WC, Chan RY, Chan SW, Tse KH, Chan JC, et al. Foreign body ingestion: Comparison of diagnostic accuracy of computed tomography versus endoscopy. J Laryngol Otol 2009;123:535-40.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2]



 

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