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Colonic perforation from grill brush bristle

Case contributed by Michael P Hartung
Diagnosis certain

Presentation

Left lower quadrant pain. Concern of colon mass based on recent colonoscopy.

Patient Data

Age: 40 years
Gender: Male

Segmental thickening and hyperenhancement of the proximal sigmoid colon asymetric to the posterior wall, with surrounding inflammation. Thin curvilinear density in the posterior wall, just deep to the serosa. No free air or fluid. 

Gross pathology

Gross pathology showing resected sigmoid colon with tattoo from preoperative colonoscopy (where cancer was suspected). 2 cm grill brush bristle was removed from the wall during pathologic sectioning. 

Case Discussion

Highly alarming case of what was originally suspected to be a colon cancer on colonscopy (hence the preoperative tattoo), but turned out to be related to a remote ingestion of a grill brush bristle that embedded into the colonic wall. 

Grill brush bristle ingestion can occur from cleaning a grill and having the small bristles fall off the brush and become lodged into the meat on the grill and unknowingly ingested. 

The imaging findings are very subtle, as only a thin curvilinear density is seen in the colon wall. Being aware of the different foreign bodies that can cause perforation (fish bone, chicken bone, grill brush) is very helpful to guide the surgical team. In this case, the bristle was only seen after pathologic sectioning, as it was embedded in the wall and covered by serosa. 

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