Cancer of unknown primary (CUP) is a well-known entity that can present in a multitude of clinical presentations. Based on the extent and organ of involvement, the presentation will be varied. For instance, patients presenting with axillary lymphadenopathy would lead toward a primary breast cancer, whereas patients presenting with abdominal distention due to ascites would tend toward a gastrointestinal origin. We present a case of a 73-year-old female who presented with an abdominal wall mass; on laparoscopy, she was found to have a spigelian hernia due to an omental metastatic lesion from a CUP.
Background: The ingestion of a foreign body is a common event. It most often occurs in young children. When ingestion occurs in adults, it is usually incidental. Individuals with psychiatric disorders, patients with dentures, and those with alcohol dependencies are more likely to ingest a foreign body accidentally. Other adults are known to ingest fish or chicken bones accidentally. The majority of ingested foreign bodies pass through the gastrointestinal tract without any complications. The minority of ingested foreign bodies will require endoscopic intervention while only ~1% require surgical intervention. Case Description: A 91-year-old female with late-stage dementia presented with abdominal pain and vomiting of 1-day duration. Computed tomography obtained in the emergency room was suggestive of partial small bowel obstruction vs. ileus. She was treated conservatively with bowel rest. After 48 hours of failed medical management, she was taken to surgery. Exploratory laparotomy identified a firm, mobile mass in mid jejunum. Surgeons performed a small bowel resection. The specimen when opened revealed a tightly compacted sheet of plastic. Postoperative the patient did well and recovered without any complications. Conclusion: This incident is the first report of a mechanical small bowel obstruction caused by ingestion of a plastic bag. Our report highlights the practice of using multiple window-computed tomography views when evaluating a patient with intestinal obstruction.
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