Penetration of the duodenum by an ingested needle with migration to transverse mesocolon

Foreign body ingestion is a common problem frequently encountered in both children and adults, but perforation of gut by sharp metallic objects is rare and rarer still is their migration. This case is about a penetration of the duodenum by an ingested needle with migration to transvers colon mezoderm.
A 21 years old man was referred to us with a four day history of ingestion a sewing needle accidentally. An abdominal roentgenogram showed the needle on the upper abdominal area. We hospitalized the patient and decided to follow him conservatively with abdominal roentgenogram because he had no symptom of perforation. He had complaint of abdominal pain after eating meal, an abdominal plain roentgenogram showed a needle
in the upper abdominal area. On general physical examination he had no clinical findings except tenderness at palpation on the upper abdomianl area. After following five day we
decided to explore the patient because the needle has not mooved at the roentgenogram. At the abdominal exploration there was no sign of peritonitis and perforation. We found the needle in the transvers colon mezoderm and extirpate the needle uneventfully.
We thougth that the needle migrated by penatrating the third part of he duodenum. The patient was extarnated the postoperative fifth day without any complication.
Management of ingested foreign bodies differs according their localizations, shapes and structures. About % 80 of ingested foreign bodies have uncomplicated spontaneous passage but a rate % 1 of sharp foreign bodies penatrates the bowel. Metallic
foreign bodies can be vizualized on plain X-rays. Ultrasonografy can be helpful. Endoscopy should be used for diagnozis and also for removing the fore›gn bodies which lodges in
the cricopharyngeal sphincter or esophagus in 24 hours.
If there is no perforation or obsbtruction the patients can be followed conservatively but the followed patient which had ingested a sharp foreign body should be explored if the foreign body did not pass through the gastrointestinal tractus with an
enough waiting time or if it does not moove at roentgenograms.

Yutulan dikiþ iðnesinin duodenumu penetrasyonu sonrasý transvers mezokolona migrasyonu