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Ingested foreign bodies mimicking inflammatory bowel disease
  1. Chenxu Shi1,
  2. Shariq Raza2,
  3. Andrew Tieniber3,
  4. Pak Chau4,
  5. Franz Fogt1
  1. 1Department Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
  2. 2Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
  3. 3Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
  4. 4Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Franz Fogt, Department of Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA; Franz.fogt{at}pennmedicine.upenn.edu

https://doi.org/10.1136/jcp-2024-209531

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    Introduction

    Inflammatory bowel disease (IBD) encompasses a group of idiopathic disorders, including Crohn’s disease and ulcerative colitis, characterised by chronic inflammation of the gastrointestinal tract. Typical symptoms include abdominal pain, diarrhoea and rectal bleeding. While the diagnosis of IBD primarily relies on clinical, endoscopic and histopathological findings, atypical presentations can complicate diagnosis.1 2

    Ingestion of foreign bodies is a relatively common clinical scenario, particularly among children and certain adult populations, such as those with psychiatric disorders.3 4 The spectrum of ingested objects ranges widely from small, benign items like coins to potentially hazardous objects such as batteries or sharp items. While many ingested foreign bodies pass through the gastrointestinal tract without causing significant harm, some can lead to acute complications.3 5 6 Very rarely, the foreign body, acting as a continuous source of irritation, can lead to chronic inflammation, ulceration and even strictures, closely resembling or exacerbating the pathological features of IBD.7–13

    Case presentation

    A 59-year-old man with a significant past medical history of bipolar disorder, chronic kidney disease, hypothyroidism due to fibrous invasive thyroiditis, and hypertension presented to the emergency department with global weakness and throat pain. He was found to have hypotension, leucocytosis, severe acute kidney injury, acidemia, concerning septic shock from an unclear source. He was initially resuscitated with crystalloid, hydrocortisone, and initiated on vasoactive support and empiric antibiotics. Despite these measures, his shock progressed requiring multiple high-dose vasopressors. His abdominal examination evolved from mild distension without tenderness, to diffuse tenderness on deep palpation, and eventually to significant guarding, rigidity and signs of peritonitis. CT imaging ultimately demonstrated multiple radiopaque linear foreign bodies (consistent with hairpins) within the stomach, second portion of duodenum and the terminal ileum (figure 1A–C, respectively), probable small bowel obstruction just distal to the terminal ileal radiopaque foreign body with tiny …

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    Footnotes

    • Handling editor Vikram Deshpande.

    • Contributors CS drafted and revised the manuscript. SR and AT revised the surgery part of the manuscript. PC revised the psychiatry part of the manuscript. FF initiated this project, revised the manuscript for final approval of the version.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.