Appendiceal foreign bodies: a case series

Ingested foreign bodies in children generally pass through the gastrointestinal tract without complications but may occasionally lodge within the appendix. Case 1 was a 7-year-old boy who presented with a two-day history of abdominal pain, vomiting, diffuse tenderness, and rebound tenderness. He had a white blood cell count of 23.4 ×10 3 /μL. On direct abdominal radiography, a radiopaque object was noted on the right side of the sacrum. Abdominal computed tomography revealed a 9-mm hyperdense focus on the pelvic inlet, suggestive of an appendicolith or a calcified lymph node. The appendix was not clearly visualized. The patient was hospitalized and started on intravenous ampicillin-sulbactam. Due to persistent symptoms for 24 hours, we took him to the operating room for an exploratory laparoscopy with a preliminary diagnosis of acute appendicitis. We identified an inflamed appendix containing a wire-like structure extending from inside the appendix through the appendiceal wall. We did an appendectomy, and he had an uneventful recovery. Case 2 was a 3-year-old girl referred to us after the incidental detection of a metal pin in the right lower quadrant on an abdominal X-ray done following a minor fall. As the pin remained stationary for one week, she underwent a colonoscopy, but the foreign body was visualized within the colon. She was sent home with the expectation that the foreign body would pass spontaneously. However, at three months of follow up, the foreign body had not moved at all, so we took her to the operating room for a diagnostic laparoscopy. We did not find the foreign body in the small bowel, but we found an edematous, hyperemic appendix, so we did an appendectomy suspecting that the foreign body could be there. Effectively, the pin was found within the appendix. Her recovery was uneventful. Swallowed foreign bodies can occasionally lodge in the appendix. Foreign bodies lodged in the appendix may remain silent or, rarely, cause appendicitis.