Vol 43 # 3 September 2011 - Kma.org.kw

September 2011
KUWAIT MEDICAL JOURNAL 241
Case Report
Appendicitis Caused by Accidentally Ingested
Metallic Pin: A Case Report
Lamya Al-Sarraf 1 , Venugopal Naik Keluth Chavan 1 , Renu Gupta 2
1
Department of Radiology, Mubarak Al-Kabir Hospital, Kuwait
2
Department of Radiology, Faculty of Medicine, Kuwait University, Kuwait
ABSTRACT
Kuwait Medical Journal 2011; 43 (3):241-243
Foreign bodies (FB) are a rare cause of appendicitis.
We report a case of a 29-year-old healthy female who
presented to the emergency department after accidentally
swallowing a pin while wearing head scarf. Plain abdominal
radiograph revealed an opaque metallic pin in the left
upper quadrant. She was sent home with reassurance.
After a week, she presented to the emergency department
again with intermittent abdominal pain. Abdominal
radiograph at this stage showed the metallic pin in the
right lower quadrant and the decision to intervene was
made. Colonoscopic removal failed as the pin could not
be visualized. Abdominal CT scan was performed which
revealed the pin within the lumen of appendix. At surgery
and histopathology, acute appendicitis with ulceration and
neutrophilic infiltration at pin contact suggested foreign
body appendicitis. Pre-operative CT scan was found to
be useful for localization of FB as well as identification of
complications.
KEY WORDS: appendicitis, CT scan, foreign body
INTRODUCTION
Foreign bodies (FB) are a rare cause of appendicitis.
Most swallowed FB, whether intentional or accidental,
eventually pass with no complications [1,2] . A vast
variety of foreign bodies have been reported within
the appendix and these can be classified into metallic,
human/animal materials, plant materials and others [1] .
Examples of some of these include pins, coins, dental
material. These objects differ in their potential
for complications like perforation as well as their
translucency. It has been reported that long, sharp,
pointed objects are more prone for perforation [1] .
The investigations and management plans differ
accordingly and have to be tailored to the case. For the
few unfortunate ones, in which the foreign body does
not pass spontaneously, or the risk of complications
is high, intervention is usually indicated. There
are several methods of retrieval of retained foreign
bodies, endoscopically or through fluoroscopically
assisted surgeries [3] . Sometimes, further radiological
investigations maybe done prior to intervention. As
in our case, the use of computed tomography (CT)
scan offered the diagnosis and accurate localization
of the foreign body. This helped guide the surgical
team to the appropriate management, i.e., the surgical
approach. Usefulness of 3D reconstruction and
reformatting in the coronal and sagittal planes in the
evaluation of complicated ingested foreign bodies
has been reported [4] . This case report emphasizes the
importance of preoperative CT scan for localization of
foreign bodies and identification of complications.
CASE HISTORY
A 29-year-old previously healthy female patient
presents to the emergency department with complaints
of accidental swallowing of a pin while wearing her
headscarf (hijab). She did not have any symptoms at this
time and physical examination was unremarkable, but
she was anxious and concerned about the swallowed
foreign body. The abdominal radiograph showed the
radio opaque metallic pin in the left upper quadrant,
probably in the jenjunal loops. She was sent home with
reassurance as most of the swallowed foreign bodies
eventually pass without intervention.
A week later, she presented to the emergency
department with intermittent abdominal pain.
Abdominal radiographs showed a radio- opaque
metallic pin in the right lower quadrant with no other
Address correspondence to:
Dr. Renu Gupta, Professor, Department of Radiology, Faculty of Medicine, Kuwait University, P O Box 24923, Safat 13110, Kuwait. Tel: (965)
24986411, Fax: (965) 2533 0473, E-mail: renu@hsc.edu.kw