Title: A Sticky Situation
Authors: Priya Ahire, Pramod Nichat, Kushagra Rahul, Soumya Chatnalkar, Saad Shaikh, Geoffrey Kharmutee, Dinesh Goswami, Dhiraj Kachare
DOI: https://dx.doi.org/10.18535/jmscr/v8i4.23
Abstract
Introduction: Gastro- diaphragmatic injury by an ingested foreign body is of an extremely rare occurrence. It has complex anesthetic and surgical management. The authors here describe the successful surgical and anesthetic management of a case of gastric fundus perforation and diaphragmatic rent caused by ingestion of a long foreign body by the patient
Case Report: A 63 year old male patient brought by relatives to the emergency department with acute onset of dyspnea and breathlessness. Plain chest x ray showed massive hydropneumothorax. Patient was resuscitated and a chest tube was inserted.
Upon ICD insertion, serous fluid was extracted. CECT of thorax and abdomen revealed a long foreign body in the stomach and perforating the fundus of the stomach, diaphragm and the lung parenchyma
This was consistent with the history of long Neem twig ingestion by the patient.
Patient was immediately operated on and the Neem stick was recovered through an iatrogenic gastrostomy and fundus wall and diaphragm were repaired. Post- operative recovery was uneventful.
Discussion: Resuscitation and close monitoring prior to and during surgery are vital. Resuscitation should be as per the ATLS protocol and immediate threats to life should be corrected before correcting the problems that do not pose immediate threats to life.
Conclusion: Gastro diaphragmatic injuries by ingested foreign bodies demand immediate life-saving measures, appropriate resuscitative care, urgent shifting of patients to tertiary care centers, prompt diagnosis and immediate surgical intervention.
Correlation of history with the presenting problem and early intervention in such cases can improve the patient outcome and minimize mortality.
Keywords: Foreign Body, Gastric Perforation, Diaphragmatic Perforation.
