Small bowel obstruction and perforation due to foreign body

Case contributed by Shanyar Hama Karim

Presentation

Status post CABG and mitral valve repair one week prior. Increasing lower abdominal pain for two days. O/E lower abdominal tenderness bilaterally, decreased bowel sounds. Labs: elevated leukocytes and CRP. Bowel ischemia? Sigmoid diverticulitis? Ileus?

Patient Data

Age: 65 years
Gender: Female

Dilated duodenal and jejunal bowel loops in the left upper quadrant with a transition point in the lower abdomen. A linear hypderdensity is seen intraluminally, at the transition point, perforating the bowel wall. Small volume of extraluminal free air can also be seen. There is thickening of the wall of the sigmoid colon with fat stranding in lower abdomen indicating accompanying colitis with peritonitis.

Small splenule. Small renal cyst on the right (Bosniak II). Chronic occlusion of the right profunda femoris and the left superficial femoral artery. Foley catheter in situ.

Bilateral lower lobe subsegmental atelectasis. Mitral valve repair. Midline sternotomy.

Photo

Intraoperative photo of the foreign body

Intraoperative photo of the foreign body (5 mg amlodipine tablet with envelope).

Case Discussion

Laparotomy revealed a swallowed amlodipine tablet with its envelope causing the perforation.

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