Gastric perforation by a foreign body presenting as a pancreatic pseudotumour

Abstract

INTRODUCTIONForeign body ingestion rarely causes complications, though it can pose a significant diagnostic challenge. Perforation, particularly of more muscular viscera, can present insidiously with a wide range of differential diagnoses.PRESENTATION OF CASEHere we present a case of 75 year-old woman presenting with chest and epigastric pain. Initial imaging suggested a pancreatic lesion. Despite appropriate treatment she deteriorated clinically, and following urgent laparotomy a duck bone fragment was found to have perforated the lesser curvature of the stomach and embedded within the liver causing subhepatic abscess formation and associated inflammation.DISCUSSIONThere are a number of examples of insidious presentations of gastrointestinal perforation. However, we have found only one other case of a perforation presenting as a pancreatic pseudotumour, and ours is the first to have been successfully managed by removal of the foreign body and drainage of the abscess alone.CONCLUSIONA high level of suspicion is required to make the correct diagnosis in cases such as these where the symptoms are not clear-cut. Thorough review and discussion of imaging prior to surgical treatment is essential to prevent unnecessary intervention.

Gastric perforation due to fish bone ingestion presenting as gastric outlet obstruction: a case report

“…Initial diagnosis can be missed and the condition may become chronic and present as pseudotumoral lesion in and around stomach even after a long time of primary event. 5,6 In the present case fish bone had perforated the posterior wall of stomach and formed an inflammatory lump in lesser sac. Occasionally the foreign body might migrate into adjacent structures like liver, spleen and form an abscess.…”

A foreign body in liver mimicking an intrahepatic cholangiocarcinoma

“…An unknown foreign body mimicking colorectal liver metastases has been reported [4]. According to two previous case reports, a foreign body could simulate carcinoma in the head of pancreas [5,6]. Except for those instances most patients had features of a liver abscess.As pre-operative diagnosis by biopsy is not favoured by many hepatobiliary surgeons, foreign body in liver mimicking a neoplasm could remain a diagnostic dilemma.…”

Successful endoscopic management of gastric perforation caused by ingesting a sharp chicken bone

“…This phenomenon is thought to be due to the characteristic thick muscular wall of these hallow organs and the presence of surrounding omentum and solid organs. Consequently, a more gradual perforation occurs coupled by a simultaneous sealing effect from nearby tissue eventually yielding – in most cases – intra-abdominal abscesses [2,4,5] . Hence, having a high degree of suspicion can aid in reaching an early diagnosis and instilling appropriate management.…”