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Colonic perforation resulting from ingested chicken bone revealing previously undiagnosed colonic adenocarcinoma: report of a case and review of literature.

McGregor DH, Liu X, Ulusarac O, Ponnuru KD, Schnepp SL - World J Surg Oncol (2011)

Bottom Line: Pathologic examination showed the foreign body to be a sliver of bone consistent with chicken bone and the sigmoid subacute perforation to be associated distally with a circumferential ulcerated obstructing mass, microscopically seen to be transmurally infiltrating adenocarcinoma, signet-ring cell type.There was extensive acute and organizing peritonitis, 100% Escherichia coli was cultured from peritoneal fluid, and the patient died two days postoperatively with sepsis and hypotension.This appears to be the fifth reported case of colonic perforation resulting from foreign body perforation due to previously undiagnosed adenocarcinoma.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA. douglas.mcgregor@va.gov

ABSTRACT
An 86 year old male with a four-day history of nonspecific gastrointestinal symptoms was found on colonoscopy to have evidence of sigmoid colon obstruction and possible perforation. Emergent operative exploration revealed diffuse peritonitis, sigmoid perforation, adjacent dense adhesions, and a foreign body protruding through the perforated area. Pathologic examination showed the foreign body to be a sliver of bone consistent with chicken bone and the sigmoid subacute perforation to be associated distally with a circumferential ulcerated obstructing mass, microscopically seen to be transmurally infiltrating adenocarcinoma, signet-ring cell type. There was extensive acute and organizing peritonitis, 100% Escherichia coli was cultured from peritoneal fluid, and the patient died two days postoperatively with sepsis and hypotension. This appears to be the fifth reported case of colonic perforation resulting from foreign body perforation due to previously undiagnosed adenocarcinoma. The four previously reported cases were all deeply invasive adenocarcinoma of sigmoid colon, and the foreign bodies included three chicken/poultry bones and a metallic staple. These five cases are highly unusual examples of a potentially lethal malignant neoplasm being clinically revealed by a usually (but not always) innocuous event, the ingestion of a small foreign body.

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Foreign body, found intraoperatively to be protruding through the colonic perforation. (A) Gross, consistent with sliver of bone, (B) Microscopic, confirming the boney nature of the foreign body.
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Figure 1: Foreign body, found intraoperatively to be protruding through the colonic perforation. (A) Gross, consistent with sliver of bone, (B) Microscopic, confirming the boney nature of the foreign body.

Mentions: Specimens received for pathologic examination included the foreign body, segment of sigmoid colon, and additional segment of sigmoid colon. The foreign body, which had been found to be protruding through the perforation, consisted of a sliver of bone measuring 2.6 × 0.2 cm (Figure 1A) and the boney nature of this foreign body was confirmed microscopically (Figure 1B). The segment of sigmoid colon had a 5.5 × 4.4 cm circumferential ulcerated mass with marked luminal obstruction and a 0.2 × 0.2 cm perforation 1.0 cm proximal to the mass. (Figure 2A, B)


Colonic perforation resulting from ingested chicken bone revealing previously undiagnosed colonic adenocarcinoma: report of a case and review of literature.

McGregor DH, Liu X, Ulusarac O, Ponnuru KD, Schnepp SL - World J Surg Oncol (2011)

Foreign body, found intraoperatively to be protruding through the colonic perforation. (A) Gross, consistent with sliver of bone, (B) Microscopic, confirming the boney nature of the foreign body.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3045974&req=5

Figure 1: Foreign body, found intraoperatively to be protruding through the colonic perforation. (A) Gross, consistent with sliver of bone, (B) Microscopic, confirming the boney nature of the foreign body.
Mentions: Specimens received for pathologic examination included the foreign body, segment of sigmoid colon, and additional segment of sigmoid colon. The foreign body, which had been found to be protruding through the perforation, consisted of a sliver of bone measuring 2.6 × 0.2 cm (Figure 1A) and the boney nature of this foreign body was confirmed microscopically (Figure 1B). The segment of sigmoid colon had a 5.5 × 4.4 cm circumferential ulcerated mass with marked luminal obstruction and a 0.2 × 0.2 cm perforation 1.0 cm proximal to the mass. (Figure 2A, B)

Bottom Line: Pathologic examination showed the foreign body to be a sliver of bone consistent with chicken bone and the sigmoid subacute perforation to be associated distally with a circumferential ulcerated obstructing mass, microscopically seen to be transmurally infiltrating adenocarcinoma, signet-ring cell type.There was extensive acute and organizing peritonitis, 100% Escherichia coli was cultured from peritoneal fluid, and the patient died two days postoperatively with sepsis and hypotension.This appears to be the fifth reported case of colonic perforation resulting from foreign body perforation due to previously undiagnosed adenocarcinoma.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA. douglas.mcgregor@va.gov

ABSTRACT
An 86 year old male with a four-day history of nonspecific gastrointestinal symptoms was found on colonoscopy to have evidence of sigmoid colon obstruction and possible perforation. Emergent operative exploration revealed diffuse peritonitis, sigmoid perforation, adjacent dense adhesions, and a foreign body protruding through the perforated area. Pathologic examination showed the foreign body to be a sliver of bone consistent with chicken bone and the sigmoid subacute perforation to be associated distally with a circumferential ulcerated obstructing mass, microscopically seen to be transmurally infiltrating adenocarcinoma, signet-ring cell type. There was extensive acute and organizing peritonitis, 100% Escherichia coli was cultured from peritoneal fluid, and the patient died two days postoperatively with sepsis and hypotension. This appears to be the fifth reported case of colonic perforation resulting from foreign body perforation due to previously undiagnosed adenocarcinoma. The four previously reported cases were all deeply invasive adenocarcinoma of sigmoid colon, and the foreign bodies included three chicken/poultry bones and a metallic staple. These five cases are highly unusual examples of a potentially lethal malignant neoplasm being clinically revealed by a usually (but not always) innocuous event, the ingestion of a small foreign body.

Show MeSH
Related in: MedlinePlus