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

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Appendicitis Caused by Accidentally Ingested Metallic Pin: A Case Report
September 2011
Fig 1: A) Plain X-ray of the abdomen showing the foreign body in the right iliac fossa, and B) a coronal reformatted CT image showing the
foreign body located in the lumen of the normal appearing appendix
abnormalities. A conservative management with
dietary advice was given. There was no evidence of
evacuation of foreign body up to two months post
ingestion. As patient continued to have intermittent
right-sided abdominal pain and physical examination
revealed tenderness in right iliac fossa, the decision to
intervene was made. Repeated abdominal radiograph
showed the pin still in the right lower quadrant,
possibly in the distal small bowel or the cecum.
Colonoscopic retrieval was attempted but the pin
could not be visualized. A small bowel Barium followthrough
examination showed the pin to be neither
in the small or large bowel and there was no other
abnormality. The appendix did not opacify during the
Fig 2: Photomicrograph shows changes of acute appendicitis
examination. Further evaluation with abdominal CT
scan was done for better localization. The CT study
showed the pin within the lumen of the appendix (Fig. 1).
No radiological evidence of appendicitis was noted.
No other bowel abnormalities or perforation were
present. The basic metabolic panel and the complete
blood count of the patient were within normal range. A
laparotomy revealed a grossly normal appendix with
the pin retained intraluminally. An appendectomy
was performed. Histopathological examination of
the resected specimen showed changes of acute
appendicitis in the form of ulceration and neutrophilic
infiltration at the point of pin contact (Fig. 2). A final
diagnosis of FB induced appendicitis was made. The
patient had an uneventful postoperative period.
DISCUSSION
Most swallowed FB, whether intentional or
accidental, eventually pass with no complications [1,2] .
FB are a rare cause of appendicitis. A large review of
appendectomies from Duke Hospital and the Durham
Veterans Administration Hospital showed only seven
of 13,228 appendectomies performed involved foreign
bodies in the appendix, an incidence of 0.0005% [3] .
A vast variety of FB 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] .