A male prisoner, 25 years old, was presented to emergency department with pain in his abdomen. He complained that the pain was roughly located at his right iliac fossa. He had intentionally ingested razor blade 12 hours prior to the onset of pain. He also had history of depression and intentional ingestion of razor blades many times. He had no symptoms. His hemodynamic stability was normal. Physical examination showed no red flags other than tenderness in the right lower quadrant.
To recognize the cause of pain in his right lower quadrant biochemical tests were run. His biochemistry didn’t reveal anything suspicious. Moreover, plain X-Rays were produced. The images revealed radiopaque objects in the right lower quadrant. According to the films, the radiopaque fragments rested in the distal small intestines or proximal large intestines.
The patient was admitted into the hospital for conservative management. Days passed but no improvement was observed. The pain in his right lower quadrant remained persistent. The radiopaque fragment, which was definitely a foreign body, remained in the same position as seen in the X-ray on the day of admission.
On fourth day of patient’s admission a CT scan was conducted. The results of CT scan demonstrated two foreign bodies in the right lower quadrant. The CT scan could not give a clear idea about the nature of foreign body. However, it was concluded that object was a man-made artifact. Fortunately, the object had not perforated any structure.
For further confirmation of the nature of foreign object in the right lower quadrant intraoperative imaging was opted. With the help of diagnostic laparoscopy, two razor blades were found in the appendix. Intraoperative imaging showed no perforation in the appendix.
Other than the tip of appendix rest of the structure was not harmed. The tip had mildly injected which lead to no serious concerns. Luckily, there were no signs of appendicitis. This happens when the bolus is passing through the large intestine. Only when the foreign body is heavier than the bolus it causes the bolus to slow down and stop temporarily in the intestines. During that time the foreign body, such as razor blades, enters the lumen of appendix. As soon as the substance enters the appendix it is unable to get back into the colon due to negligible peristalsis. Sharp objects usually cause perforations. The patient in this case is fortunate to have no perforation.
In order to relieve pain surgical removal of the two razor blades from appendix was approved. By following the laparoscopic surgical technique the razor blades were efficiently removed from the appendix. In this technique, the appendix is first skeletonized very well. Skeletonizing appendix means to remove the serosal tissues from the appendix so that it becomes feasible for the surgeon to proceed. The appendix is skeletonized between two snares. Next, the two razor blades were removed from the appendix.
This surgery had no complications and the patient was discharged after one day.
