Occurrence of multiple fistulas decades after ingestion and neglect of numerous thermometers: a case report

Abstract

Background Ingestion of thermometers is a very rare occurrence and associated with penetrations of hollow organs. An event decades ago can lead to the development of fistulas. Case presentation We present a case of a 62-year-old male who swallowed multiple thermometers with a length of up to 22 cm over a period of 40 years. Diagnostic imaging presented a retroperitoneal abscess due to a duodenal perforation of the longest thermometer as well as multiple other thermometers stuck in the small intestine. After all thermometers were removed and the abscess drained, the patient showed a clinical deterioration. In further operations we found a duodeno-sigmoid fistula and a gastro-thoracal fistula, which were not visible in the initial operations and imaging. Conclusion We recommend an active search for fistulas especially in the case of long-foregone ingestion.

An extraluminal migration of a gastrointestinal foreign body to the anterior abdominal wall: A rare case report

“…Small and blunt objects tend to pass through the gastrointestinal tract without complications in most cases, whereas sharp and elongated foreign bodies are more likely to get held up in the bowel and result in their penetration and perforation. In addition to foreign body characteristics, the risk of impaction can increase in the presence of structural and functional abnormalities of the GI tract like diverticulum, webs, rings, strictures, achalasia, tumours, duodenal ulcer sequelae, hernia, and postgastrectomy status [ 3 , 7 , 10 ]. A foreign body causes a bowel perforation frequently at the point of acute angulation and narrowing, even though it can cause perforation anywhere.…”

“…However, one should bear in mind that the foreign body during surgery may not be located exactly as it was in the CT scan. Additionally, a preoperative imaging search for fistulas is necessary, especially in patients with long-foregone foreign body ingestion and an object located in angled regions of the intestinal tract [ 2 , 5 , 10 , 12 , 14 ]. In our case, preoperatively, we made a diagnosis of an extraluminaly migrated gastrointestinal foreign body with the formation of an abdominal wall abscess with a high index of suspicion for the presence of a fistula.…”