A Rare Complication of an Ingested Foreign Body: Gallbladder Perforation

We present a 13-year-old child who admitted with a dull right upper quadrant pain that started 3 weeks before her referral. Several medications were given but they did not change the intensity and the frequency of the pain. Her physical examination was nonspecific except for slight right upper quadrant tenderness. The imaging studies revealed a sewing pin perforating the stomach and gallbladder. The patient was treated with a successful operation, and no postoperative complications were observed. To our knowledge, this is the first case of a sharp foreign body gallbladder perforation in a child. 1. Introduction Ingestion of foreign bodies (FB) is a common problem during childhood, alerting the family but having relatively low complication rates. While most of these objects leave the alimentary tract without a complicating course, sharp objects may perforate the viscera and present as acute abdomen [1, 2]. We report a 13-year-old girl presenting with a persistent dull abdominal pain. The child remembered that she has swallowed a pin about three weeks prior to her admission after the demonstration of a radio-opaque FB in abdominal X-ray. The report differs from the others with its presentation, which is not an acute abdomen, and presence of gallbladder perforation after piercing the stomach. As far as we know, despite a case in an adult, this is the only child case reported in the literature. 2. Case A 13-year-old girl was admitted to our clinic for intermittent blunt abdominal pain presenting mostly after the meals. The pain was consistent and did not relieve with medications. The physical examination was notable only for slight right upper quadrant (RUQ) tenderness. The biochemical and hematological values were within normal limits. On abdominal X-ray, a radio opaque image was seen. With the deepened history, we learned that the patient has swallowed a sewing pin about three weeks prior to her admission. She was interned due to the location and long stay of the pin for further evaluation. An abdominal ultrasound revealed a 38？mm FB perforating the stomach from antrum and lying over the gallbladder of its superior pole. The 30？mm part of the pin was outside the stomach, and gallbladder wall was edematous (13？mm). We planned and performed laparotomy on the same day. During the exploration, stomach and the surrounding tissues were observed to be adherent to each other with marked tissue edema, and serous fluid was oozing from the area (Figures 1(a)-1(b)). Dissection over the inflamed area revealed a sewing pin perforating the stomach from the anteromedial