Duodenocolic fistula by nail ingestion in a child
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Ingestion of foreign bodies (FBs) is encountered commonly in the pediatric population, with a peak incidence in children aged 6 months–3 years. Most ingested FB (80–90%) pass through the gastrointestinal tract spontaneously; only <1% cause significant complications, such as perforations, which require surgical intervention. A 3-year-old male child was admitted, with a history of accidental ingestion of construction nail for 30 days, without any symptoms. Parents consulted in a peripheral hospital and plain abdominal radiography showed a nail projected in right-edge upon the lumbar spine. The clinical observation was advised. The nail did not pass spontaneously and the child remained asymptomatic. Parents decided to consult again, but in our institution (surgery department). The child did not experience fever nor digestive symptoms (nausea, vomiting, abdominal pain, blood or color changes in stool). He had no prior history of FB ingestion.

Abdominal examination was normal. A repeat abdominal radiography was done. The nail’s position had not changed from the first X-ray site, with no free peritoneal air. Urgent laparotomy exploration was planned. Intraoperatively, the nail was impacted and palpated through the ascending colon wall. The nail was extracted through a minim colic incision centered on its head, measuring ~6 cm. The ascending colon was mobilized, showing a second part of duodenum anterior wall, and ascending colon posterior wall perforations. There was neither peritonitis nor intraperitoneal free fluid. No spillage was noticed in the peritoneal cavity. Intraoperative diagnosis of duodenocolic fistula by nail ingestion was made. All perforations were repaired primarily (by multiple simple interrupted sutures) and drain was placed near repairs. The follow-up was uneventful. The child was discharged on day 8.

Source: https://academic.oup.com/jscr/article/2020/8/rjaa187/5896198