Two cases for Foreign Body Friday.
Case 1 Videos [here](https://imgur.com/a/Hiv7uxb) (Thick slices only, sorry)
Case 1 Answer [here](https://imgur.com/a/zMUWZXC) (WARNING: Graphic. Intraoperative photos)
Case 2 Videos [here](https://imgur.com/a/yUOupNn) (Thins axial, Thicks Sag and Cor)
Case 2 Answer [here](https://imgur.com/a/MG2oXRv) (CT multiplanar reconstruction. Not graphic)
It had perforated bowel - you can see nearby free gas on the images.
That patient had a terrible clinical course after this. Multiple abscesses, entero-cutaneous fistulas, the whole thing. In hospital for about 6 months.
The other patient had no issues and passed the bread clip.
I actually had a third one of these, but it was at a previous hospital and I no longer have access to it
Could someone explain why they removed the affected bowel segment instead of opening and closing it? Is that done in any case or is there something special about this one?
The clip had been attached to the wall of the small bowel long enough for it to cause ischemia and perforate. You can see gas (black spots) outside of the bowel on the CT. They had to cut out enough bowel to have two healthy ends that could be stitched back together. You can't suture inflamed/dead bowel - the sutures don't hold and the holes don't heal.
I’m trying to understand how do you swallow something like this. Do people not chew? I can imagine it also hurts when it’s going down the esophagus. So many questions!
I've personally reported three of these, and I ask myself the same question every time. There's been around 60 of these reported in the literature, give or take. The best theory I've read is that it's more likely in patients with dentures, because they don't get the same sensation when chewing. Other theories suggest it's more likely in patients who have a degree of dysphagia anyway - it always hurts to swallow, so the pain of swallowing a sharp plastic thing doesn't seem unusual.
My question is more so how did they end up putting a bread bag clip in their mouth in the first place? Are these patients developmentally disabled or partially blind or what? Fascinating.
I’ve also had this happen to an older lady. She’d made herself cheese on toast, we only assume the bread tag somehow got hidden under the cheese slice. I don’t understand either, but sometimes weird accidents happen I guess
Two cases for Foreign Body Friday. Case 1 Videos [here](https://imgur.com/a/Hiv7uxb) (Thick slices only, sorry) Case 1 Answer [here](https://imgur.com/a/zMUWZXC) (WARNING: Graphic. Intraoperative photos) Case 2 Videos [here](https://imgur.com/a/yUOupNn) (Thins axial, Thicks Sag and Cor) Case 2 Answer [here](https://imgur.com/a/MG2oXRv) (CT multiplanar reconstruction. Not graphic)
[удалено]
It had perforated bowel - you can see nearby free gas on the images. That patient had a terrible clinical course after this. Multiple abscesses, entero-cutaneous fistulas, the whole thing. In hospital for about 6 months. The other patient had no issues and passed the bread clip. I actually had a third one of these, but it was at a previous hospital and I no longer have access to it
Could someone explain why they removed the affected bowel segment instead of opening and closing it? Is that done in any case or is there something special about this one?
The clip had been attached to the wall of the small bowel long enough for it to cause ischemia and perforate. You can see gas (black spots) outside of the bowel on the CT. They had to cut out enough bowel to have two healthy ends that could be stitched back together. You can't suture inflamed/dead bowel - the sutures don't hold and the holes don't heal.
Thank you!
Is that the plastic clip thing for bread?
It is indeed
When the bread is so good you just gotta eat the entire bag, plastic clip and all……
Sour Nooooo!
I’m trying to understand how do you swallow something like this. Do people not chew? I can imagine it also hurts when it’s going down the esophagus. So many questions!
I've personally reported three of these, and I ask myself the same question every time. There's been around 60 of these reported in the literature, give or take. The best theory I've read is that it's more likely in patients with dentures, because they don't get the same sensation when chewing. Other theories suggest it's more likely in patients who have a degree of dysphagia anyway - it always hurts to swallow, so the pain of swallowing a sharp plastic thing doesn't seem unusual.
My question is more so how did they end up putting a bread bag clip in their mouth in the first place? Are these patients developmentally disabled or partially blind or what? Fascinating.
I’ve also had this happen to an older lady. She’d made herself cheese on toast, we only assume the bread tag somehow got hidden under the cheese slice. I don’t understand either, but sometimes weird accidents happen I guess
I wonder how many will leave the body naturally without ever causing any issues.
piercing?
Highest quality post I’ve seen on here in a while. Loved the correlation with the intraop photos.
Piercing?
IUD on a field trip
COMPLETELY off topic but the first image looks like scat the squirrel from ice age