Small bowel perforation by a piece of china with a synchronous asymptomatic sigmoid carcinoma: A case report
© Nunes et al; licensee BioMed Central Ltd. 2008
Received: 15 August 2008
Accepted: 30 September 2008
Published: 30 September 2008
A 75 year old gentleman who presented with an incarcerated paraumibilical hernia was found intraoperatively to have small bowel perforation due to a piece of china with a synchronous asymptomatic sigmoid carcinoma.
Ingestion of a sharp foreign body is mostly accidental, though it may occur in mental impairment and alcoholism. Gastrointestinal perforations can occur at any site along the tract, mainly at narrowings, angulations or in anatomic cul-de-sacs.  The ileum is the most common site of foreign body ingestion.  A preoperative diagnosis of a perforation by a sharp foreign body is rarely made because the clinical presentation is non-specific and can mimic a number of surgical conditions like appendicitis or diverticulitis. An unenhanced abdominal radiograph shows no specific findings and non-metallic objects are rarely visualised. An erect chest radiograph may show gas under the diaphragm. In our patient, the incarcerated paraumbilical hernia was presumed to be responsible for his clinical presentation necessitating surgery. Foreign body perforation through a sigmoid carcinoma leading to an incidental discovery of the tumour has been described [3, 4]. However, small bowel perforation by a piece of china with a synchronous asymptomatic sigmoid carcinoma incidentally discovered at surgery has not been reported. The concurrent aymptomatic Meckel's diverticulum did not require surgery while the asymptomatic Duke's B sigmoid carcinoma was appropriately resected. The occurrence of multiple pathologies in the same patient namely symptomatic incarcerated paraumbilical hernia and the small bowel perforation due to a sharp foreign body along with the asymptomatic Meckel's diverticulum and sigmoid carcinoma make this the first case of its kind to be reported.
Written informed consent was obtained from the patientfor publication of this case report and accompanying images. A copy of this written consent is available for review by the Editor-in Chief of this journal.
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