Preoperative use of ultrasonography to localize an ingested foreign body

Piotto, Lino; Gent, Roger; Kirby, Christopher P.; Morris, Lloyd

doi:10.1007/s00247-008-1096-2

Cited by 28 publications

(16 citation statements)

References 3 publications

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“…While a dependency on the patient's morphological characteristics, the location of the perforation, and the performance of the operator are acknowledged limitations, the substantial increases in the diagnostic ability of new US systems have led to improved image quality when examining the intestine, even in larger patients and in deeper areas of the abdomen (14). US can also be uniquely valuable in pediatric cases as a means to identify the exact location of an ingested foreign body that has not passed to the feces, facilitating its surgical removal (15). Improved US image quality combined with a high index of suspicion for foreign bodies when performing US of acute abdomen cases may allow a larger number of correct diagnoses to be made.…”

Section: Discussionmentioning

confidence: 99%

Acute abdomen caused by small bowel perforation by a clinically unsuspected fishbone: a case report

Drakonaki

Chatzioannou²,

Spiridakis³

et al. 2010

Diagn Interv Radiol

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A ccidental foreign body ingestion is commonly encountered in clinical practice. However, bowel perforation by a foreign body is less common, as the majority of foreign bodies uneventfully pass to the feces and only 1% of them (the sharper and more elongated objects) will perforate the gastrointestinal tract, usually at the level of the ileum (1). Computed tomography (CT), especially multidetector CT (MDCT), is considered the method of choice for preoperative diagnoses of ingested foreign bodies and their complications due to its high-quality multiplanar capabilities and high resolution (2-6). The increased availability and effectiveness of MDCT has limited the use of ultrasonography (US) in investigations of acute abdominal pain (2). As a result, only a few older reports (using outdated equipment) have investigated the use of US in the diagnosis of ingested foreign bodies (7-10).Herein, we report a case of small bowel perforation and omental granuloma caused by a clinically unsuspected fish bone in which US led to a precise preoperative diagnosis and successful surgical treatment. In the era of MDCT, we highlight the usefulness of current-generation US as a radiation-free investigative tool in cases of acute abdominal pain caused by ingested foreign bodies. Case reportA 78-year-old overweight woman presented to the emergency department of our hospital with a three-day history of increasing periumbilical abdominal pain and persistent vomiting. Upon clinical examination, there was tenderness with guarding of the right upper abdomen and an elevated temperature (38.5 °C). Laboratory tests revealed increased inflammatory markers including a white blood cell count of 18.7x10 3 /μL (85% neutrophils) and a C-reactive protein level of 180 mg/L. The remaining blood test parameters were unremarkable.An abdominal X-ray in the supine position showed the presence of a distended small bowel loop at the middle abdomen but no signs of free abdominal gas or other remarkable findings (Fig. 1). The patient was referred for an abdominal US, which revealed the presence of a markedly hypoechoic mass with minimal vascularity. The mass measured approximately 4.5 cm in diameter at the right periumbilical area and contained a thin, straight, hyperechoic structure measuring 3.3 cm in length that was associated with slight posterior shadowing depending on the probe position. The fat surrounding the lesion was intensely hyperechoic, and there was an aperistaltic hypoechoic sentinel small bowel loop adjacent to the mass and connected to it by way of a linear hypoechoic sinus tract (Fig. 2). These findings raised suspicion that a foreign body was present, as this could cause both a small bowel perforation and a reactive mass.Because the patient was rapidly deteriorating, a CT scan was not performed, and the clinical decision was made to perform an urgent surgical ABSTRACT We report the case of a 78-year-old woman with a three-day history of abdominal pain and vomiting. An abdominal plain film showed a distended small bowel loop and no signs ...

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Section: Discussionmentioning

confidence: 99%

Acute abdomen caused by small bowel perforation by a clinically unsuspected fishbone: a case report

Drakonaki

Chatzioannou²,

Spiridakis³

et al. 2010

Diagn Interv Radiol

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“…Linear, high-frequency transducers can be used to evaluate for foreign bodies and can help guide selection of subsequent targeted radiographs [93][94][95][96][97] . Metallic and non-metallic foreign bodies are typically echogenic with posterior shadowing [93] .…”

Section: Foreign Bodymentioning

confidence: 99%

Abdominal ultrasonography of the pediatric gastrointestinal tract

Gale¹,

Gee²,

Westra³

et al. 2016

WJR

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Ultrasound is an invaluable imaging modality in the evaluation of pediatric gastrointestinal pathology; it can provide real-time evaluation of the bowel without the need for sedation or intravenous contrast. Recent improvements in ultrasound technique can be utilized to improve detection of bowel pathology in children: Higher resolution probes, color Doppler, harmonic and panoramic imaging are excellent tools in this setting. Graded compression and cine clips provide dynamic information and oral and intravenous contrast agents aid in detection of bowel wall pathology. Ultrasound of the bowel in children is typically a targeted exam; common indications include evaluation for appendicitis, pyloric stenosis and intussusception. Bowel abnormalities that are detected prenatally can be evaluated after birth with ultrasound. Likewise, acquired conditions such as bowel hematoma, bowel infections and hernias can be detected with ultrasound. Rare bowel neoplasms, vascular disorders and foreign bodies may first be detected with sonography, as well. At some centers, comprehensive exams of the gastrointestinal tract are performed on children with inflammatory bowel disease and celiac disease to evaluate for disease activity or to confirm the diagnosis. The goal of this article is to review up-to-date imaging techniques, normal sonographic anatomy, and characteristic sonographic features of common and uncommon disorders affecting the gastrointestinal tract in children.

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“…Although point-of-care US has been widely used to identify soft tissue and skin foreign bodies, 1,2,9 there have been only a few case series describing the use of point-of-care ultrasonography for the detection of intestinal foreign bodies in children. 10,11 Although ultrasonography has FIGURE 6. Case 2.…”

Section: Review Of the Literaturementioning

confidence: 99%