D0113 - Chicken Ticca: Hard Object, Wrong Hole

Gilad Shapira, DO¹, Itamar Shapira, MBA², Akshay Mentreddy, DO³, Arun Sharma, PhD⁴, Vikas Sethi, DO⁵, Deep Patel, DO⁶, Shivani Trivedi, DO⁷, Geoffrey Goldsberry, DO¹, Daniel Golpanian, MD, MPH⁸, Michael Castillo, MD⁹, Smruti Mohanty, MD¹⁰, Haripriya Maddur, MD¹¹, Muhammad Khan, MD, MPH¹¹, Meir Mizrahi, MD^12
1HCA Healthcare/USF Morsani College of Medicine GME, Largo Medical Center, St. Petersburg, FL; ²UAB Heersink School of Medicine, Birmingham, AL; ³UCSF Medical Center, San Francisco, CA; ⁴Cedars-Sinai Medical Center, Los Angeles, CA; ⁵Largo Medical Center, Largo, FL; ⁶HCA Healthcare/USF Morsani College of Medicine GME, Largo Medical Center, Clearwater, FL; ⁷HCA Healthcare/USF Morsani College of Medicine GME, Largo Medical Center, Largo, FL; ⁸NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY; ⁹New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY; ¹⁰Newark Beth Israel Medical Center, Newark, NJ; ¹¹HCA West Florida Largo Medical Center, Largo, FL; ¹²HCA West Florida Largo Medical Center, St. Petersburg, FL

Introduction: Diverticular disease is a common, largely age dependent condition that occurs due to herniation of the mucosa and submucosa through the muscularis propria often at levels of vasa recta penetration. This condition is typically asymptomatic with approximately 4% of patients developing diverticulitis. Fewer than 20% may exhibit symptoms of rectal bleeding, abdominal pain, abscess, perforation or peritonitis. Risk factors include obesity, smoking, and low-fiber diet. Rarely, diverticulitis is caused by ingestion of foreign body (IFB). Unlike typical scenarios of diverticulitis, endoluminal examination and intervention in cases of IFB may be paramount.

Case Description/Methods: The patient is a 58 year old female presenting with left lower quadrant abdominal pain as well as vomiting, diarrhea and fever for one day. Upon presentation, the patient had a leukocytosis (WBC 20.3) with associated tenderness. A Computed Tomography (CT) scan revealed pericolonic inflammatory changes of the sigmoid colon including a tubular 50 x 3mm structure suspicious for a foreign body (Figure 1). Given the clinical picture, Piperacillin/Tazobactam was initiated and a sigmoidoscopy was performed. Upon endoscopy, a chicken wing bone was visualized within a diverticulum and removed successfully utilizing a 10mm snare (Figure 2). The patient’s WBC normalized and her symptoms improved. Subsequently, she tolerated a diet and was discharged on Ciprofloxacin/Metronidazole for 1-week course.

Discussion: Diverticulitis unrelated to IFB has been theorized to occur either due to overgrowth of intestinal flora within a diverticulum or due to localized immune dysregulation. IFB mostly occurs in the elderly, those with psychiatric disorder as well as those with alcohol abuse. Most causative foods (chicken bones, fish bones, etc.) pass without issue. That said there are cases of complications such as colonic perforation, diverticulitis as well as abscesses occurring due to IFB. Utilization of cross-sectional imaging offers diagnostic utility for the radiopaque IFB. The findings of diverticulitis plus a foreign body should be of concern as complications may occur. Typically, in cases of acute diverticulitis, endoscopy is not performed due to operative risk in the setting of active inflammation. In this scenario, early endoluminal intervention and successful foreign object extraction was key to the patients positive clinical outcome and likely prevented further potential complications.



Disclosures:


Gilad Shapira, DO¹, Itamar Shapira, MBA², Akshay Mentreddy, DO³, Arun Sharma, PhD⁴, Vikas Sethi, DO⁵, Deep Patel, DO⁶, Shivani Trivedi, DO⁷, Geoffrey Goldsberry, DO¹, Daniel Golpanian, MD, MPH⁸, Michael Castillo, MD⁹, Smruti Mohanty, MD¹⁰, Haripriya Maddur, MD¹¹, Muhammad Khan, MD, MPH¹¹, Meir Mizrahi, MD¹². D0113 - Chicken Ticca: Hard Object, Wrong Hole, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.