Duodenocolic fistula by nail ingestion in a child

Unintentional foreign body ingestion is common among children. Normally, these ingested foreign bodies pass spontaneously. Only few of them may lead to complications such as fistula, which requires surgical intervention. We are reporting a case of accidental construction nail ingestion in a 3-year-old male child, for 30 days, without any symptoms. Diagnosis of duodenocolic fistula by construction nail was made on clinical examination and abdominal radiography features. He underwent surgical intervention, with nail removal, dudenal and colic primary closure. The follow-up was uneventful. We recommend emergently retrieval of sharp-pointed and long-ingested foreign bodies like a construction nail. Conservative outpatient management by clinical observation is not appropriate for this kind of foreign bodies. It may lead to complications such as perforation and fistula.

Iliopsoas Abscess as the First Clinical Manifestation of Crohn’s Disease - A Rare Case Report and Literature Review

Objective: Iliopsoas abscess is a rare complication of fistulizing Crohn’s disease, which is difficult to diagnose and manage. We report this case to alert clinicians to the diagnosis and management of this unusual association. Case presentation: A 31-year-old male who presented with right groin pain, and hip pain due to an iliopsoas abscess. He was found to have iliopsoas fistula and underlying Crohn’s disease. The right iliopsoas abscess was managed with CT guided percutaneous drainage and pigtail catheter placement and intravenous antibiotics. The patient was started on mesalamine and prednisone. A month later, the patient became symptomatic again and a duodenocolic fistula was found. A laparoscopic extended right hemicolectomy with both fistulas takes-down, end ileostomy and mucus fistula were performed. Pathology revealed chronic active Crohn’s ileocolitis. His ileostomy was reversed three months later. The patient recovered uneventfully and was doing well after six-month follow-up. Conclusions: Iliopsoas abscess can be a rare presentation of Crohn’s disease. Evaluation with CT imaging, and initial management with drainage and antibiotics are recommended. Surgical intervention should be considered early for impending arthritis.

Gallstone Ileus Caused by a Cholecysto-Duodeno-Colic Fistula, Case Report And Literature Review

Introduction: Complex cholecysto-duodeno-colic fistulas are an extremely rare complication that can occur in patients with cholelithiasis. The aim of this article is to present the case of a pacient with cholecystoduodeno- colic fistula manifested with biliary ileus in a patient known for many years with cholelithiasis. Case report: We present the case of a 62 y/o male that was admitted in our clinic with the diagnosis of gallstone ileus. Emergency surgical intervention was needed. Intraoperatively we discovered a cholecysto-duodenocolic fistula complicated with gallstone ileus. During the operation we practiced retrograde cholecystectomy, closure of the fistulous tract (duodenoraphy, coloraphy), enterotomy and extraction of the calculus located inside the small intestine. The postoperative evolution was favorable. Conclusions: Cholecysto-duodeno-colic fistulas complicated with gallstone ileus are an extremely rare complication that can occur in patients with gallstones. In case of the occurrence of gallstone ileus, the surgical treatment is an emergency, being the only therapeutic technique that can save the patient’s life.