Intestinal obstruction due to migration of a thermometer from bladder to abdominal cavity: a case report


Nie, J.; Zhang, B.; Duan, Y-Chao.; Hu, Y-Hua.; Gao, X-Ying.; Gong, J.; Cheng, M.; Li, Y-Qing.

World Journal of Gastroenterology 20(9): 2426-2428

2015


Intraperitoneal foreign bodies such as retained surgical instruments can cause intestinal obstruction. However, intestinal obstruction due to transmural migration of foreign bodies has rarely been reported. Here, we report a case of intestinal obstruction due to a clinical thermometer which migrated from the bladder into the abdominal cavity. A 45-year-old man was admitted to our hospital with a one-year history of recurrent lower abdominal cramps. Two days before admission, the abdominal cramps aggravated. Intestinal obstruction was confirmed with upright abdominal radiography and computerized tomography scan which showed dilation of the small intestines and a thermometer in the abdominal cavity. Then laparotomy was performed. A scar was observed at the fundus of the bladder and a thermometer was adhering to the small bowels and mesentery which resulted in intestinal obstruction. Abdominal cramps were eliminated and defecation and flatus recovered soon after removal of the thermometer.

World
Journal
of
Gastroenterology
Online
Submissions:
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World
J
Gastroenterol
2014
March
7;
20(9):
2426-2428
ISSN
1007-9327
(print)
ISSN
2219-2840
(online)
doi:10.3748/wjg.v20.i9.2426
©
2014
Baishideng
Publishing
Group
Co.,
Limited.
All
rights
reserved.
CASE
REPORT
Intestinal
obstruction
due
to
migration
of
a
thermometer
from
bladder
to
abdominal
cavity:
A
case
report
Jing
Nie,
Bo
Zhang,
Yan-Chao
Duan,
Yue-Hua
Hu,
Xin-Ying
Gao,
Jian
Gong,
Ming
Cheng,
Yan-Qing
Li
Jing
Nie,
Bo
Zhang,
Yan-Qing
Li,
Department
of
Gastroenter-
ology,
Qilu
Hospital,
Shandong
University,
Jinan
250012,
Shan-
dong
Province,
China
Yan
-
Chao
Duan,
Department
of
Internal
Medicine,
Affiliated
Hospital
of
Taishan
Medical
University,
Taian
271000,
Shandong
Province,
China
Jing
Nie,
Yue
-
Hua
Hu,
Xin
-
Ying
Gao,
Jian
Gong,
Department
of
Gastroenterology,
Taian
Central
Hospital,
Taian
271000,
Shan-
dong
Province,
China
Bo
Zhang,
Department
of
Infections,
Taian
Central
Hospital,
Taian
271000,
Shandong
Province,
China
Ming
Cheng,
Department
of
General
Surgery,
Taian
Central
Hospital,
Taian
271000,
Shandong
Province,
China
Author
contributions:
Nie
J
and
Zhang
B
contributed
equally
to
this
work;
Nie
J,
Zhang
B,
Duan
YC,
Hu
YH,
Gao
XY,
Gong
J,
Cheng
M
and
Li
YQ
collected
the
data
and
managed
and
re-
viewed
the
case;
Nie
J
and
Zhang
B
wrote
the
paper.
Correspondence
to:
Yan
-
Qing
Li,
Professor,
Department
of
Gastroenterology,
Qilu
Hospital,
Shandong
University,
107
West
Wenhua
Road,
Jinan
250012,
Shandong
Province,
China.
Telephone:
+86-538-6298473
Fax:
+86-538-8223227
Received:
October
21,
2013
Revised:
November
14,
2013
Accepted:
January
8,
2014
Published
online:
March
7,
2014
Abstract
Intraperitoneal
foreign
bodies
such
as
retained
surgical
instruments
can
cause
intestinal
obstruction.
However,
intestinal
obstruction
due
to
transmural
migration
of
foreign
bodies
has
rarely
been
reported.
Here,
we
re-
port
a
case
of
intestinal
obstruction
due
to
a
clinical
thermometer
which
migrated
from
the
bladder
into
the
abdominal
cavity.
A
45-year-old
man
was
admitted
to
our
hospital
with
a
one-year
history
of
recurrent
lower
abdominal
cramps.
Two
days
before
admission,
the
abdominal
cramps
aggravated.
Intestinal
obstruction
was
confirmed
with
upright
abdominal
radiography
and
computerized
tomography
scan
which
showed
dilation
of
the
small
intestines
and
a
thermometer
in
the
ab-
dominal
cavity.
Then
laparotomy
was
performed.
A
scar
was
observed
at
the
fundus
of
the
bladder
and
a
ther-
mometer
was
adhering
to
the
small
bowels
and
mesen-
tery
which
resulted
in
intestinal
obstruction.
Abdominal
cramps
were
eliminated
and
defecation
and
flatus
re-
covered
soon
after
removal
of
the
thermometer.
©
2014
Baishideng
Publishing
Group
Co.,
Limited.
All
rights
reserved.
Key
words:
Intestinal
obstruction;
Foreign
body;
Ther-
mometer;
Transmural
migration;
Bladder
Core
tip:
Intestinal
obstruction
due
to
transmural
mi-
gration
of
foreign
body
is
a
rare
condition.
Here
we
report
a
case
of
intestinal
obstruction
due
to
transmural
migration
of
a
thermometer
from
the
bladder
to
the
abdominal
cavity.
The
patient
recovered
soon
after
re-
moval
of
the
thermometer.
Nie
J,
Zhang
B,
Duan
YC,
Hu
YH,
Gao
XY,
Gong
J,
Cheng
M,
Li
YQ.
Intestinal
obstruction
due
to
migration
of
a
thermometer
from
bladder
to
abdominal
cavity:
A
case
report.
World
J
Gas-
troenterol
2014;
20(9):
2426-2428
Available
from:
URL:
http://
www.wjgnet.com/1007-9327/full/v20/i9/2426.htm
DOI:
http://
dx.doi.org/10.3748/wjg.v20.i9.2426
INTRODUCTION
Intraperitoneal
foreign
bodies
are
common
events
in
chil-
dren,
alcoholics,
psychiatric
patients
and
criminals
111
.
They
can
be
categorized
as
either
intraluminal
or
extraluminal
of
gastrointestinal
tract.
Intraluminal
ones
are
usually
ingested
coins,
buttons,
pins,
batteries
and
so
on
121
.
They
can
be
lodged
in
narrow
areas
(i.e.,
pylorus
and
ileocecal
valve),
resulting
in
obstruction
or
perforatiod
l
.
Extralu-
minal
ones,
such
as
retained
surgical
sponges,
are
infre-
quently
encountered
in
patients
who
have
been
treated
with
prior
surgery
or
some
other
interventional
medical
procedures.
They
can
lead
to
intestinal
obstruction
or
abscess
formation
with
or
without
secondary
bacterial
**
ail
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2426
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I
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I
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I
Nie
3
et
al.
Intestinal
obstruction
due
to
a
thermometer
P
-
Figure
3
Thermometer
coated
with
pus
was
seen
pressing
on
the
small
bowels
and
mesentery.
Figure
1
Abdominal
X-ray
showed
dilation
of
the
small
intestines,
gas-
fluid
levels
and
a
thermometer-like
object
in
the
abdominal
cavity.
Figure
2
Computerized
tomography
scan
revealed
thin
walls
of
intestines
and
a
thermometer-like
object
in
the
lower
quadrant
of
the
abdomen
(A,
B).
infection
°I
.
Foreign
bodies
can
be
detected
by
abdominal
radiography
and
computerized
tomography
(C1)
141
.
Here
we
report
a
rare
case
of
intestinal
obstruction
due
to
transmural
migration
of
a
thermometer
from
the
bladder
to
the
abdominal
cavity.
CASE
REPORT
In
April
2013,
a
45-year-old
man
was
admitted
to
our
hospital
with
a
one-year
history
of
recurrent
lower
ab-
dominal
cramps.
The
symptoms
could
be
alleviated
with
antibiotic
treatment.
Two
days
before
admission,
the
abdominal
cramps
aggravated,
and
defecation
and
flatus
stopped.
On
physical
examination,
he
had
a
regular
pulse
of
82
beats/min,
a
respiratory
rate
of
20
breaths/min,
and
a
temperature
of
37.6
°C.
His
cardiopulmonary
and
neurologic
examinations
were
normal.
Abdominal
ex-
amination
revealed
distension
with
lower
abdomen
ten-
derness
and
rebound
tenderness.
Abdominal
rumbling
sound
was
weak.
Blood
routine
test
revealed
a
white
blood
cell
count
of
8.78
x
10
9
/L,
neutrophil
87.41%,
lymphocyte
8.3%,
hemoglobin
concentration
12.8
g/dL,
and
platelet
count
173
x
10
9
/L.
The
serum
level
of
C-re-
active
protein
was
75.1
mg/L.
Abdominal
radiography
showed
dilation
of
the
small
intestines,
gas-fluid
levels
and
a
thermometer-like
object
in
the
abdominal
cavity
(Figure
1).
CT
scan
revealed
thin
walls
of
the
intestines
and
a
thermometer-like
object
in
the
lower
quadrant
of
abdominal
cavity
(Figure
2).
He
was
diagnosed
with
in-
testinal
obstruction.
The
patient
was
addicted
to
alcohol.
When
he
was
drunk,
he
would
behave
strangely.
He
admitted
that
he
had
inserted
a
thermometer
into
the
urinary
passage
through
the
penis
two
years
ago
without
referring
to
a
doctor.
Subsequently,
he
experienced
increased
urinary
frequency
and
urgency
and
enlarged
testicles
with
pain.
For
this,
he
would
take
antibiotics
to
control
the
pain.
After
the
examinations,
the
patient
was
sent
to
the
operation
room
immediately
and
exploratory
laparotomy
was
performed
via
lower
abdominal
midline
incision.
After
opening
the
abdomen,
much
purulent
exudative
fluid
was
sucked
out.
A
scar
was
observed
at
the
fun-
dus
of
the
bladder
and
a
thermometer
was
adhering
to
the
small
bowels
and
mesentery,
resulting
in
intestinal
obstruction
(Figure
3).
Three
hundred
milliliters
of
nor-
mal
saline
was
injected
to
the
bladder
through
a
urinary
catheter
during
the
operation
and
no
fluid
exuded
from
around
the
scar.
Abdominal
cramps
were
eliminated
and
defecation
and
flatus
recovered
soon
after
removal
of
the
thermometer.
DISCUSSION
This
is
a
case
report
of
intraperitoneal
foreign
body
that
led
to
intestinal
obstruction.
This
patient
denied
inges-
tion
of
foreign
bodies
or
prior
surgical
surgery.
We
found
that
the
obstruction
was
due
to
a
thermometer
migrating
from
the
bladder
to
the
abdominal
cavity.
When
there
is
a
breakage
on
the
bladder
wall,
bacteria
can
travel
between
T**
an
WI
dons®
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www.wjgnet.com
2427
March
7,
2014
I
Volume
20
Issue
9
Nie
3
et
al.
Intestinal
obstruction
due
to
a
thermometer
the
urinary
passage
and
the
abdominal
cavity,
leading
to
urinary
infection
and
infra-abdominal
inflammation,
which
can
be
alleviated
with
antibiotic
therapy
as
seen
in
our
patient.
The
scar
at
the
fundus
of
the
bladder
is
the
evidence
of
perforation.
Furthermore,
our
patient
was
al-
coholic
with
psychiatric
problems.
He
admitted
inserting
a
thermometer
into
urinary
passage
two
years
before.
Urinary
system
foreign
bodies,
especially
bladder
ones,
are
frequently
encountered.
Most
of
them
come
from
the
urinary
tract
that
are
inserted
by
the
patients
themselves
because
of
being
curious
about
sex
and
geni-
tal
organ
15-71
.
But
perforation
of
bladder
is
rarely
reported.
It
manifests
as
increased
urinary
frequency
and
urgency,
hematuria,
abdominal
pain,
etc.
In
our
case,
fortunately,
the
thermometer
was
not
broken,
otherwise
it
would
cause
severe
clinical
events,
such
as
intestinal
perforation
and
mercury
poisoning".
To
our
knowledge,
this
is
the
first
case
report
of
intestinal
obstruction
due
to
transmural
migration
of
a
thermometer
from
the
bladder
to
the
abdominal
cavity.
Based
on
our
experience,
a
thorough
history
of
patients
should
be
acquired
to
confirm
the
ingestion
or
insertion
of
any
foreign
bodies.
If
patients
showed
signs
of
intes-
tinal
obstruction,
surgery
should
be
performed
to
avoid
further
complications.
OMMENTS
Case
characteristics
A
45-year-old
man
presented
with
recurrent
lower
abdominal
cramps.
Clinical
diagnosis
Abdominal
distension
with
lower
abdomen
tenderness
and
rebound
tenderness.
Differential
diagnosis
Intestinal
neoplasm,
abdominal
abscess,
and
urinary
tract
infection.
Laboratory
diagnosis
WBC
8.78
x
10
9
/L,
Neutrophil
87.41%,
and
CRP
75.1
mglL.
Imaging
diagnosis
Abdominal
radiography
and
computerized
tomography
scan
showed
dilation
of
the
small
intestines
and
a
thermometer-like
object
in
the
abdominal
cavity.
Treatment
Exploratory
laparotomy
was
performed
and
a
thermometer
was
removed.
Related
reports
This
is
the
first
case
report
of
intestinal
obstruction
due
to
transmural
migration
of
a
thermometer
from
bladder
to
abdominal
cavity.
Experiences
and
lessons
Foreign
object
detained
in
the
bladder
can
penetrate
into
the
abdominal
cavity
and
cause
intestinal
obstruction
and
peritonitis.
Peer
review
This
case
report
describes
a
rare
condition
that
intestinal
obstruction
occurred
due
to
a
clinical
thermometer
which
migrated
from
the
bladder
into
the
abdomi-
nal
cavity.
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L-
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ail
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www.wjgnet.com
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7,
2014
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20
I
Issue
9
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