Mechanical bowel obstruction caused by a foreign body (clam shell)

Case contributed by Dr Domenico Nicoletti

Presentation

Abdominal pain with vomiting three days after eating clam chowder. White blood cell count was 32.000 U/μL, with neutrophilia (90%); other blood tests were in normal range. Body temperature was 39.2°C.

Patient Data

Age: 40 years
Gender: Female

There are multiple dilated jejunal loops in the upper and middle abdomen. There is no air in the rectosigmoid. In the right iliac fossa there is a clam shell of about 2 cm.

CT scan shows mechanical bowel obstruction caused by clam shell at the distal ileum with pneumoperitoneum and peritoneal effusion by bowel perforation. The small bowel feces sign and dilated proximal bowel loops are also identified. Left ovary enlarged.

Immediate laparotomy revealed the shell in the distal small bowel.

Resection of the last ileal loop and cecum with ileo-colic isoperistaltic anastomosis.

Case Discussion

Initial abdominal plain radiograph should be obtained when foreign body ingestion is suspected, which differentiates a radiopaque from radiolucent foreign bodies. Computed tomography with 3D reconstruction (3D-CT) is recommended with radiolucent foreign bodies. The presence of intestinal obstruction necessitates surgical intervention to extract the ingested foreign body.

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