Presentation
Abdominal pain and constipation for 3 days
Patient Data
On transverse US scan, multiple prominent bowel loops (jejunal and ileal) filled with fluid and echogenic intraluminal contents were noted throughout the abdomen. Tracing these bowel loops to the right iliac fossa (RIF) revealed a tubular echogenic foreign body (i.e. straw) with posterior acoustic shadow in the terminal ileum and collapsed cecum.
Trace free fluid with floating echoes was also noted in the RIF (not shown in the image).
Surgical photos show the foreign body.
Case Discussion
During US scanning, if dilated bowel loops are traced sequentially, we may be able to identify the point of transition and the etiology of bowel obstruction (as the tubular straw in this case). Thus, a meticulous ultrasound scan can guide clinical decision-making and prevent the need for further imaging and exposure to radiation (especially important in the pediatric population).
In case of foreign body ingestion, the presence of even a trace amount of echogenic intraabdominal free fluid should raise the possibility of bowel perforation (as evidenced by the intraoperative finding in the last image).
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