Using iconographic material from our department of the last 10 years,
we illustrated and collected the plain abdominal radiography,
US and abdominopelvic CT,
showing various complications of FB.
We have made a selection of the cases according to the rarity of the diagnosis or the complications caused.
Our hospital medical records were screened retrospectively and the FB were classified according to the mode of introduction:
• Ingestion;
• Insertion (transrectal);
• Iatrogenic.
FB ingestion
Incidence
The reported incidence of FB causing perforation of the gastrointestinal tract is less than 1%,
with the objects being elongated or sharp in most of the cases,
such as toothpicks,
pins,
fish or chicken bones.
Complications
• Mechanical obstruction - FB frequently lodge at areas of anatomical narrowing,
physiological angulation or areas of pathological structures.
Ingested objects are usually elongated and became trapped in the duodenum,
appendix or ileocecal valve.
Spherical or cylindrical objects tend to be large and impact in the esophagus or pylorus.
• Perforation - The most common sites for perforation are the lower esophagus,
duodenal loop,
appendix,
ileocecal valve and the recto-sigmoid region.
• Fistula,
abscess,
peritonitis or generalized septicemia – usually as a result of perforation.
Diagnosis
For the study of FB in gastrointestinal tract it is very important to select the most appropriate imaging modality.
• Radiograph detects as much as 80% of all FB.
Objects of metal (except aluminum),
most animal bones and glass are opaque on radiographs,
unlike fish bones.
Objects composed of plastic and most fish bones are radiolucent structures and their diagnosis may be challenging.
• US is the method of choice in the diagnosis of a FB that migrated from the gastrointestinal tract and retained in the soft tissues.
• CT scanning is helpful as it identifying a high density FB and its complications.
The region of perforation may appear as a thickened local segment,
associated with localized pneumoperitoneum,
regional fatty infiltration and eventually associated intestinal obstruction.
FB insertion
Voluntarily inserted FB into the various orifices can be due to several reasons including sexual pleasure or curiosity.
Typical locations include the rectum,
nose,
genitourinary tract and ear.
Introduction into the rectum may be through self-insertion and imaging modalities are fundamental in evaluating the location,
size of the FB and possible complications.
The plain pelvic radiograph is simple,
accessible and easily repeatable.
Iatrogenic procedures
Numerous medical devices are found in everyday practice by almost all radiologists.
Some,
are used to monitor a patient's condition others have therapeutic uses.
The most suitable method of removing the FB depends on the size and mobility of the object applied and associated complications.
When possible,
endoscopic and minimal invasive techniques of removal should be used.