A Combined Laparoscopic and Endoscopic Approach in a Case of Foreign Body Induced Gastric Perforation – A Case Report

Introduction: Foreign body ingestion resulting in perforation is a rare complication seen in 1% of cases. Clinical signs of perforation can vary widely and there is often a delay to presentation.

Presentation of Case: A 51-year-old lady presented with a history of abdominal pain which was exacerbated by eating. She had an elevated white blood cell count and C-Reactive protein. A computed tomography scan of her abdomen revealed a collection of gas and fluid in her lesser sac from a suspected perforation near her gastric antrum. A diagnostic laparoscopy was performed but did not reveal an obvious cause for the perforation. A gastroscopy showed a sharp plastic foreign body protruding from the posterior gastric antrum. It was removed with an endoscopic grasper.

Discussion: The majority of ingested foreign bodies will pass without incident with only 1% causing perforation. Most cases can be managed conservatively. Surgical intervention is indicated when the foreign body is deemed high risk for causing injury, such as a battery or a long sharp object, or if a complication has already occurred. The common sites for perforation in the gastrointestinal tract are areas of narrowing or angulation. These are usually the ileocaecal and rectosigmoid regions.

Conclusion: Ingested foreign body perforation in the general adult population is usually secondary to accidental ingestion and is frequently caused by dietary foreign bodies. A preoperative history of foreign body ingestion is rarely obtained. Foreign body perforations of the stomach, duodenum or large intestine tend to present with a longer, more innocuous clinical picture than perforations of the jejunum or ileum.