P0446 - A Prepyloric Stomach Barricade: A Rare Cause of Abdominal Pain

Abdullahi Musa, MBBS¹, Ahmed Brgdar, MBBS¹, Angesom Kibreab, MD², Victor Scott, MD³, Farshad Aduli, MD^2
1Howard University Hospital, Washington, DC; ²Howard University College of Medicine, Washington, DC; ³Howard University, Washington, DC

Introduction: The majority of ingested foreign bodies (IFB) pass through the stomach without any complication. However some IFBs can cause significant complications like bowel obstruction, bleeding, abscess formation, perforation or gastric wall impaction. Most patients do not recall the initial ingestion thus the diagnosis is often delayed. Here we report a case of a patient presented with abdominal pain due to impacted prepyloric chicken bone which was removed endoscopically.

Case Description/Methods: A 55 – years-old woman presented to the emergency room complaining of gradual onset epigastric abdominal pain for one week. She describes her pain as sharp in nature and constant aggravated with eating and drinking without relieving factors. She reported nausea but no vomiting. Patient denied use of non-steroidal anti-inflammatory drugs. Physical examination negative for fever and other vital signs were within normal limit. Abdomen was soft without guarding or rigidity. Laboratory studies were within normal range. A CT abdomen revealed a hyperdense foreign body in the antrum puncturing both the anterior and posterior walls with adjacent wall thickening. No free air was noted on the CT (Figure A). Upper endoscopy showed a foreign body, penetrating the prepyloric area at both mucosal ends (Figure B). The foreign body was removed endoscopically using a forceps. The hood was used for safe removal through the esophagus (Figure C). The inspection of the foreign body after removal confirmed a 3 cm chicken bone (Figure C). Patient recalled eating a chicken meal two weeks prior to this presentation. After clear liquids diet was advanced to regular diet. Abdominal pain resolved completely, and she discharged home after 24 Hours of observation with 8 weeks of oral acid suppressive therapy.

Discussion: Impacted Intragastric chicken bone is a rare etiology of abdominal pain. Per American society of gastrointestinal endoscopy guidelines endoscopic removal is indicated if foreign body is greater than 6 cm in length and 2.5 in diameter. This case highlights and reinforces the role of endoscopy in removing penetrated foreign bodies in the stomach to avoid more invasive intervention like surgery which carries high risk of complications and longer hospital stay. Therefore, the role of endoscopy in an impacted and penetrated intragastric foreign body should always be considered.


Figure: Figure A: CT Abdomen with and without contrast.
Figure B: Prepyloric chicken bone seen on the endoscopy.
Figure C: Endoscopic removal of chicken bone.


Disclosures:
Abdullahi Musa indicated no relevant financial relationships.
Ahmed Brgdar indicated no relevant financial relationships.
Angesom Kibreab indicated no relevant financial relationships.
Victor Scott indicated no relevant financial relationships.
Farshad Aduli indicated no relevant financial relationships.


Abdullahi Musa, MBBS¹, Ahmed Brgdar, MBBS¹, Angesom Kibreab, MD², Victor Scott, MD³, Farshad Aduli, MD². P0446 - A Prepyloric Stomach Barricade: A Rare Cause of Abdominal Pain, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.