Presentation
Presented with fever and fecal matter in the stoma bag. Gastrostomy tube (Foley catheter) sucked into small bowel several days earlier.
Patient Data
Foley catheter with inflated balloon in ileal loop (see standalone coronal oblique image). Part of the proximal loops are mildly distended, all ileal loops distal to the balloon are collapsed, as well as the entire colon.
New Foley catheter in stomach, with its balloon between 1st and 2nd duodenal segments.
Jejunal loops show thickened walls; moderate amount of free intraperitoneal fluid; markedly thickened gallbladder wall - findings can be explained by hypoalbuminemia (albumin 1.6 g/dL).
Fibroid filling and distending the endometrial cavity.
Enlarged cardiac atria. CVC tip deep in right atrium.
Bilateral pleural effusion, accompanied by significant bilateral lower lobe compression atelectasis with air bronchogram.
Compression fractures of T11 and T12 with mild height loss. Very mild anterolisthesis of L5 on S1. Bilateral lumbarization of S1.
Underwent colonoscopy with the intent of extricating the Foley catheter from the ileum. No catheter identified.
Post-colonoscopy chest x-ray shows a copious amount of free intra-abdominal air.
Case Discussion
History of dementia, bedridden. A Foley catheter that served as a gastrostomy tube got sucked by peristalsis into the small bowel. Received a checkup by a surgeon, abdominal x-ray did not show a foreign body. A new catheter was inserted and she was transferred back to the nursing home.
Was returned to the ED several days later due to fever and fecal matter in the gastrostomy bag. CT abdomen showed the Foley catheter in an ileal loop, causing small bowel obstruction (SBO).
Underwent colonoscopy, during which the endoscope was advanced ~100 cm into the ileum but no catheter was seen. A chest x-ray taken after the procedure showed a substantial amount of pneumoperitoneum.
Was urgently taken to the OR for exploratory laparotomy. Upon entering the peritoneum, there was free air and a large amount of small bowel content and the small bowel walls were covered in fibrin. The inflated Foley catheter balloon was palpated ~100 cm proximal to the ileocecal valve. ~120 cm proximal to the ileocecal valve, a tiny perforation was noticed. The catheter was extracted through an incision made upstream to the balloon and both the incision and perforation were closed.
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