S3703 Colonic Pseudodiverticulum Formation Secondary to Foreign Body Impaction: A Case Report

Introduction: Foreign bodies (FB) in the gastrointestinal tract are common, often resulting in an uncomplicated outcome. In adults, it is predominant in patients with psychiatric conditions, intoxication, or in high-risk populations (prisoners). Most foreign bodies that pass through the esophagus can be defecated; however, impaction may occur due to the characteristics of the foreign body or anatomical variations. In this case, we report the impaction of a foreign body in the ascending colon that required endoscopic management. Case Description/Methods: A 26-year-old woman with a history of migraines and overweight consulted the gastroenterology department with cramping abdominal pain located in the left abdomen associated with abdominal distension and constipation for the previous 2 months. Vital signs were within normal limits. Physical examination revealed a soft, depressible, and tender abdomen in the left hemiabdomen. An abdominal computed tomography (CT) scan with contrast showed no abnormalities that could explain the symptoms. A colonoscopy was performed, which revealed a 1.2 cm diverticulum-like lesion in the hepatic flexure covered with fecal matter. Since there was no evidence of diverticulosis in the rest of the colon, a pseudodiverticulum caused by a foreign body was suspected. The fecal matter was removed, revealing a sharp, wooden foreign body 0.8 cm long, which was also removed. The patient was seen 1 month later without symptoms. Discussion: The ingestion of long, narrow, sharp FB can cause impaction in the gastrointestinal tract, leading to local and systemic complications due to perforation, fistula or abscess formation, peritonitis, or obstruction. Impaction is common in the duodenum and sigmoid colon, with abdominal pain being the most common symptom. Cases of pseudodiverticulum have been reported in the sigmoid colon and esophagus; however, the ascending colon is rarer. Historically, management of retained foreign bodies was surgical; however, endoscopic management should be considered if feasible.