Lead shot incarceration in appendix: an unusual cause of appendicular foreign body

Abstract

A previously fit man was investigated for right-sided abdominal pain and an appendicular foreign body (FB) caused by ingested lead shot was found. He had associated urinary tract infection causing his symptoms and hence was treated conservatively. We present this rare case, followed by discussion of the causes, investigations, clinical significance and management of appendicular FBs.

Appendiceal Foreign Bodies in Adults: A Systematic Review of Case Reports

“…On the retrospective review of 64 case reports [5, (from 1971 to 2022) describing appendicitis induced by foreign body and fulfilling the inclusion criteria, we recorded the patient age, gender, type of foreign body, diagnostic imaging identifying the FB in the appendix, and management. Cases were reported from 25 countries, with 18 cases reported from USA [8][9][10][11][12][13][14][15][16][17][18][19], seven from UK [5,[20][21][22][23][24][25], five from Japan [26][27][28][29][30] and Korea [31][32][33][34][35] each, three from the Netherlands [36][37][38] and from Turkey [39][40][41]. Australia [42,43], Ecuador [44,45], Italy [46,47] and Taiwan [48,49] each had two cases while the rest of the following reported only one case: Austria, Cameroon, China, Croatia, France, Germany, Iran, Ireland, Kuwait, Morocco, New Zealand, Peru, Saudi Arabia, Singapore and Spain…”

A ‘Bit’ of Appendicitis: A Case of a Foreign Object in the Adult Appendix

“…Despite many patients being asymptomatic once the object is in the appendix, an appendectomy is still the standard of management to avoid inflammatory changes and perforation. This is particularly true for foreign bodies with sharp, thin, and non-flexible edges as these objects have been associated with perforation in 70% of cases [8]. There is more controversy surrounding the management of blunt objects as they are more likely to remain dormant for longer periods of time [9,10].…”

“…There is more controversy surrounding the management of blunt objects as they are more likely to remain dormant for longer periods of time [9,10]. While there is no universal agreement among clinicians regarding management of these cases, approximately 66% of these patients eventually become symptomatic [8]. Thus, lack of symptoms in the setting of an appendicular foreign body should not affect one’s decision to act prophylactically with laparoscopic appendectomy.…”

Shotgun pellet ingestion: two cases unique to the Northern Territory

“…Case reports of complications from pellet ingestion have been identified in the literature in the Inuit population in northern Canada who hunt and eat game meat regularly, the Alaskan population from eating waterfowl and hunters who eat rabbit meat 3–5 . However, these reports involve pellets localized within the vermiform appendix leading to appendiceal luminal obstruction and subsequent appendicitis.…”

“…2 Case reports of complications from pellet ingestion have been identified in the literature in the Inuit population in northern Canada who hunt and eat game meat regularly, the Alaskan population from eating waterfowl and hunters who eat rabbit meat. [3][4][5] However, these reports involve pellets localized within the vermiform appendix leading to appendiceal luminal obstruction and subsequent appendicitis. In the case of patient A, the pellets seen on CT correspond with the location of perforation seen intraoperatively, hence it is likely the pellets have migrated extraluminally and caused the perforation; to our knowledge, this is the first reported case in Australia of perforation from ingestion of pellets after eating Magpie geese.…”