AB138. SOH23ABS_124. Small bowel perforation secondary to foreign body ingestion mimicking acute appendicitis in radiation enteritis: case report

Background: Foreign body ingestion is not uncommon, however, 80–90% of ingested foreign bodies pass spontaneously. Although perforation can occur anywhere along the Gastrointestinal tract, the most common site is at the distal ileum. Chronic radiation small bowel changes can present with spectrum of symptoms. We report a case of a lady who accidently swallowed a ring that was in a brack, and had a small bowel perforation.

Case Presentation: A 71-year-old lady presented with abdominal pain. She has a background history of cervical cancer treated by chemo-radiotherapy. On Physical examination she had tenderness in the right iliac fossa wit guarding, elevated inflammatory markers; the impression at the time was acute appendicitis. That was confirmed on CT scan. She had laparoscopic appendectomy. However, she failed to settle clinically and biochemically. She then proceeded to have a second CT scan that showed an intra-abdominal collection with gas pockets. At formal laparotomy, foreign body was identified at the perforation site in the terminal ileum, which turned out to be a wrapped ring that she possibly had in a brack a couple of days ago. Small bowel segmental resection and ileostomy was undertaken. She gradually improved and discharged home.

Conclusions: Foreign body ingestion can be insidious if the patient did not mention it, and operating in an irradiated bowel can be hazardous. However, foreign body perforation can only be treated surgically.

Keywords: Radiation enteritis; irradiated bowel; perforated bowel; case report; acute appendicitis