Abdominal pain in the left lower quadrant with sepsis, not always diverticulitis. Case report
DOI:
https://doi.org/10.53903/01212095.237Keywords:
Intestinal perforation, Abdominal pain, Foreign body, PneumoperitoneumAbstract
A 50-year-old male patient, who was admitted to the emergency service due to 7 days of abdominal pain in the left lower quadrant. Laboratory studies documented leukocytosis with elevated acute phase reactants (CRP and ESR), acute kidney injury, fever, and tachycardia. In the initial imaging studies, a chest x-ray and an abdominal x-ray were requested, which showed no alterations. Given the clinical symptoms, the poor x-ray findings, the patient’s age, and the high suspicion of diverticulitis, a CT scan of the abdomen and pelvis was requested with gastrointestinal contrast medium only. The tomography revealed a hyperdense, linear image located on the lateral wall of the sigmoid colon, with some small bubbles of local pneumoperitoneum. The patient is re-interrogated and reports recent consumption of chicken “down to the bones.” The patient was taken to the operating room due to suspicion of perforation due to a foreign body and the diagnosis is confirmed.
Downloads
References
Sung HK, Sang SS, Yong YJ, Suk HH, Jin WK, Heoung KK. Gastrointestinal tract perforation: MDCT findings according to the perforation sites. Korean J Radiol. 2009;10(1):63-70. https://doi.org/10.3348/kjr.2009.10.1.63
Pouli S, Kozana A, Papakitsou I, Daskalogiannaki M, Raissaki M. Gastrointestinal perforation: clinical and MDCT clues for identification of aetiology. Insights Imaging. 2020;11(1). https://doi.org/10.1186/s13244-019-0823-6
Rasheed A, Deshpande V, Slanetz P. Colonic perforation by ingested chicken bone. Am J Roentgenol. 2001;176(1):152. https://doi.org/10.2214/ajr.176.1.1760152
Kornprat P, Langner C, Mohadjer D, J. Mischinger H. Perforation eines Sigmadivertikels durch einen Hühnerknochen in die rechte Leiste mit nachfolgender Bauchdeckenphlegmone. Wien Klin Wochenschr. 2009;121(5-6):220-2. https://doi.org/10.1007/s00508-009-1157-7
Terrace JD, Samuel J, Robertson JH, Wilson RG, Anderson DN. Chicken or the leg: Sigmoid colon perforation by ingested poultry fibula proximal to an occult malignancy. Int J Surg Case Rep. 2013;4(11):945-7. https://doi.org/10.1016/j.ijscr.2013.08.001
Guelfguat M, Kaplinskiy V, Reddy SH, DiPoce J. Clinical guidelines for imaging and reporting ingested foreign bodies. Am J Roentgenol. 2014;203(1):37-53. https://doi.org/10.2214/AJR.13.12185
Gore R, Levine M. Textbook of gastrointestinal radiology. 5th edition. Estados Unidos: Elselvier; 2021.
Pickhard P. Positive oral contrast material for abdominal CT: Current clinical indications and area of controversy. Am J Roentgenol. 2020;215:69-78. https://doi.org/10.2214/AJR.19.21989
Lugo-Fagundo C, Ghodasara N, Fishman EK, Azadi JR. CT evaluation of self-induced and retained foreign bodies in the abdomen and pelvis. Clin Imaging. 2021;80:26-35. https://doi.org/10.1016/j.clinimag.2021.06.029
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Revista Colombiana de Radiología
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
La Revista Colombiana de Radiología es de acceso abierto y todos sus artículos se encuentran libre y completamente disponibles en línea para todo público sin costo alguno.
Los derechos patrimoniales de autor de los textos y de las imágenes del artículo como han sido transferidos pertenecen a la Asociación Colombiana de Radiología (ACR). Por tanto para su reproducción es necesario solicitar permisos y se debe hacer referencia al artículo de la Revista Colombiana de Radiología en las presentaciones o artículos nuevos donde se incluyan.
