The ingestion of foreign bodies is a common cause for presentation in the emergency department by pediatric, adult, or elderly psychiatric patients. Swallowed foreign bodies sometimes represent a great challenge for surgeons due to the obstruction or perforation of the digestive tube’s upper or lower segments. Occasionally, the foreign bodies detected in the lower parts of the digestive tube (colon and rectum) could be introduced through the anal route with the risk of perforation of the rectum or sigmoid colon. In this report, we describe a unique case of a foreign body located in the sigmoid colon, where it arrived due to backstabbing and was retained for 7 years without acute symptoms. The 43-year-old male patient came to the emergency department with pain in the left iliac fossa. Before his presentation, a computerized tomography (CT) scan examination had suggested a foreign body. A surgical approach was decided. The surgery started as an exploratory laparoscopy and was converted to a xiphoid-pubic incision to extract the foreign body (a piece of glass about 8 cm long) through a sigmoid colotomy followed by a double-layer sigmoidorrhaphy. The postoperative evolution of the patient was uneventful. As far as we know, this is the first case of a patient with a foreign glass body positioned in the sigmoid colon that got there by stabbing and not by ingestion or introduced per anum. In conclusion, we suggest that aggressive behavior and abdominal wall penetration by different sharp objects should be considered when foreign bodies are detected in the abdomen.
Acute diverticulitis is a frequent complication in patients with colonic diverticulosis. The diagnosis is based on the clinical presentation, biological markers and imaging. Abdominal ultrasonography is, in many centers, the first examination in patients presenting with abdominal pain. Bowel ultrasonography has the advantage of being an inexpensive, nonionizing, readily available and repeatable examining method, but needs an experienced operator, and it is, thus, not widely used in clinical practice. We present a case series of acute diverticulitis, using bowel ultrasonography to establish the diagnosis in three different clinical settings: uncomplicated diverticulitis, abscess complicated diverticulitis and neoplasia associated diverticulitis. The patients were examined at admission, abdominal pain being the main symptom. The ultrasound examination started with a 3-5 MHz probe as in the case of classic ultrasound, followed by a 5-11 MHz probe examination that allowed adequate investigation of the bowel loops and establishing a diagnosis of acute diverticulitis based on ultrasonographic criteria. All patients had the diagnosis confirmed by a computer tomography scan and subsequently underwent antibiotic treatment. All patients had ultrasonographic characteristics suggesting parietal inflammation, overlapping with the lesions observed at CT scan which were indicative of acute diverticulitis. Both imaging techniques were able to show complications and extraintestinal alterations. Abdominal ultrasound is the imaging method most frequently used in patients presenting with abdominal pain. By using the appropriate transducer, acute diverticulitis and complications could be accurately diagnosed.
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