Jemds.com Case Report J. Evolution Med. Dent. Sci./eISSN- 2278-4802, pISSN- 2278-4748/ Vol. 7/ Issue 04/ Jan. 22, 2018 Page 548 INTESTINAL OBSTRUCTION IN PAEDIATRIC AGE GROUP DUE TO FOREIGN BODY INGESTION Pankaj Kumar Saunakiya 1 , Satendra Rajput 2 , Santosh Kumar Saroj 3 , Santvir Singh 4 , Rajkumar Verma 5 1 Lecturer, Department of Surgery, MLB Medical College, Jhansi, U. P. 2 Lecturer, Department of Surgery, MLB Medical College, Jhansi, U. P. 3 Senior Resident, Department of Surgery, MLB Medical College, Jhansi, U. P. 4 Senior Resident, Department of Surgery, MLB Medical College, Jhansi, U. P. 5 Assistant Professor, Department of Surgery, MLB Medical College, Jhansi, U. P. HOW TO CITE THIS ARTICLE: Saunakiya PK, Rajput S, Saroj SK, et al. Intestinal obstruction in paediatric age group due to foreign body ingestion. J. Evolution Med. Dent. Sci. 2018;7(04):548-549, DOI: 10.14260/jemds/2018/123 PRESENTATION OF CASE An eight-year-old girl presented with chief complaints of abdominal pain associated with abdominal distension and paucity of faeces and flatus for four days. Pain was colicky in nature, mostly involving lower part of the abdomen. Patient gave a past history of ingestion of multiple foreign bodies in the form of small marbles. (1) On physical examination, her abdomen was distended. Guarding and rigidity were absent and crackling sound was present over the lower part of her abdomen. Digital rectal examination revealed some marbles in the anal canal. CLINICAL DIAGNOSIS Clinically, the case was diagnosed as subacute intestinal obstruction caused by foreign body ingestion. DIFFERENTIAL DIAGNOSIS Differential diagnosis of subacute intestinal obstruction can be made by band, volvulus, intussusceptions, malformation and foreign body ingestion. PATHOLOGICAL AND RADIOLOGICAL DISCUSSION Laboratory studies showed Hg- 9.4 mg%, TLC- 7500, platelet count 80000/mm 3 . Serum albumin- 2.5 gm/dL. Blood urea, Multiple small stones in small Intestine ‘Financial or Other Competing Interest’: None. Submission 01-09-2017, Peer Review 06-01-2018, Acceptance 13-01-2018, Published 22-01-2018. Corresponding Author: Dr. Pankaj Kumar Saunakiya, PR-14, MLB Medical College Campus, Jhansi. E-mail: drpankajsaunakiya@gmail.com DOI: 10.14260/jemds/2018/123 serum creatinine and serum electrolytes were within normal limits. (2,3,4,5) On imaging, x-ray abdomen showed opacity in the whole lower abdomen and multiple dilated bowel loops. Multiple thick walled hypoechoic to echogenic bowel segment with large amount of gas shadows and few dilated bowel loops. CT scan of the abdomen showed multiple hyperdense opacities with central hypodense area diffusely scattered in the whole abdomen, predominantly in small bowel loop, suggestive of faecolith and large amount of foreign bodies, suggestive of small bowel obstruction. DISCUSSION OF MANAGEMENT The patient underwent emergency exploratory with the finding of dense encasement of whole small bowel and large bowel suggestive of abdominal cocoon. On meticulous adhesiolysis, highly distended terminal ileum and caecum were found. (6,7) Palpation of the bowel showed discrete, small, hard foreign bodies in lumen of small bowel which were extracted manually. These marbles weighted about half a kilogram. Resection of part of terminal ileum and ascending colon done with fashioning of double barrel stoma. Postoperative course was eventful and the patients died after one day. Incision shows bowel with Dense Adhesion