Detection of a Foreign Body during Laparoscopy for Differential Diagnosis in a Patient with Ascites

Table of Contents

A 67-year-old woman was admitted to the emergency department with complaints of abdominal pain and distension for 20 days. She had not previously undergone surgery or suffered any accident. Abdominal ascites was detected. The ascites was exudative (leukocytes 2000/mm³, lactate dehydrogenase (LDH) 6060 U/L and glucose 0 mg/dL), and the patient was therefore transferred to our clinic. Streptococcus pyogenes grew in the ascites culture after a few days

During the laparoscopic examination, the visible peritoneal regions were covered with a 2-mm thick exudate and fresh fibrous bands were observed; a 6-7 cm by 1 mm yellow object was also detected at the upper part of the pelvic region and removed by means of biopsy forceps (Figures [1], [2]). The peritoneal biopsy sample was interpreted as fibrous peritonitis. The patient was discharged in a healthy condition after 1 week's treatment with ampicilline sulbactam combination therapy, and had no complaint at follow-ups 2 and 6 months later.

Figure 1 A foreign body in the abdomen at the upper part of the pelvic region.

Figure 2 The removed foreign body.

The foreign body was identified as plastic material by the forensic medicine department.

Of the foreign bodies that go into the gastrointestinal tract, 80-90 % are excreted with no complication, 10-20 % require endoscopic removal, and about 1 % require surgical therapy [1] [2]. The rate of foreign body-related perforations has been reported to be 1 % [2]. There are several reports of perforations caused by chickenbones, fishbones, or toothpicks.

During a laparoscopic appendectomy, Neuman et al. [3] found a toothpick that perforated the cecum, but they were unable to find out how and when the toothpick had been swallowed. We were also unable to elucidate these questions in the case presented here. If the history provides no information that a foreign body was ingested or if the object is not radio-opaque, the specific reason for the complications usually cannot be identified. Here, we demonstrate the use of laparoscopy as a practical method that should be routinely used for the diagnosis and treatment of unidentified abdominal pain as well as in cases of ascites.

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References

• 1 Gongavare R D, Rose J S, Berdon W E. et al . Intrasplenic foreign body.  Am J Surg. 1972;  124 994-996
• 2 Selivanov V, Sheldon G F, Cello J P. Management of foreign body ingestion.  Ann Surg. 1984;  199 187-191
• 3 Neumann U, Fielitz J, Ehlert G. Perforation des Coecums durch einen Zahnstocher-seltene Differenzialdiagnose der akuten Appendicitis.  Chirurg. 2000;  71 1405-1408