Swallowing of sharp metallic foreign bodies is a common in medical practice. It can be a deliberate act or by chance. The first report was mentioned in early 1700s [1]. At that time, not only was dressmaking/tailoring purely manual work leading to the swallowing of sewing needles often held between the lips, but eating of shot game was also still widespread. Today, the overall incidence has dropped to 0.005% [2]. Almost all swallowed foreign bodies pass through gastrointestinal tract in the stool without causing any significant disorders [3]. Sometimes foreign bodies can change their course and penetrate the hollow organ wall, but this is rare and usually quiet [4]. These foreign bodies may move forward to almost any intra-abdominal organ [5]. Often, the identification of a moved foreign body is coincidental when patients appear with unrelated symptoms [6].

We are presenting an unusual case of an unexpected extra luminal finding of metallic foreign body in abdominal cavity without history of ingestion which was accidentally found by imaging. The patient was admitted and managed in our surgical department of Rabin Medical Center, Beilinson Hospital.

A 42-year-old male usually healthy except episode of mild biliary pancreatitis one month ago attended surgical outpatient clinic. The patient brought the results of imaging MRCP which he electively passed as a step of the preparation for elective surgery— cholecystectomy. He was absolutely asymptomatic last time. The big metallic foreign body in the area of gallbladder was mentioned in the report of MRCP.

The patient denied ingesting of foreign body. His past medical history is clean and excludes deliberate self-harm, taking overdose of medications, bulimia nervosa, anxiety and alcohol excess. He has no past surgical history. The patient also denied swallowing any foreign object in the past. He has no pain or other symptoms referable to this object. On examination, there was no scar visible in the abdominal wall.

Computed tomography (CT) scan of the abdomen was performed to assess the foreign object. Computed tomography scan showed a radio-dense elongated foreign body measuring 20 mm deep to intra-abdomen fat of right upper quadrant in the area of gallbladder lying in its left side (Figure 1).

The patient was asymptomatic related to this foreign body. So, in outpatient clinic was considered to perform elective operation— laparoscopic cholecystectomy with removal of foreign body.

The patient was admitted electively and taken to operation theatre. The patient underwent uneventful laparoscopic cholecystectomy. During the operation the foreign reminiscent of a needle was found stuck in the omentum closed to pylorus (Figure 2) (Figure 3) (Figure 4). He made an uneventful recovery and was discharged home with further follow-up.

Ingestion of foreign bodies can occur in adults or children. Case reports of swallowed sharp metallic body perforating the hollow viscus of abdomen, though presenting in literature are surprisingly rare [5]. Complication of foreign body swallowing such as perforation and dislocation of it may be insensitive to the patient [6]. A foreign body can be detected accidentally as part of a patient’s radiological examinations for very different reasons. Often, this leads to the surprise of both the doctor and the patient [5]. Sometimes, the foreign body leads to more severe consequences, including perforation, intestinal obstruction, and dislocation of foreign body to almost any sites of abdomen cavity [7].

There was no correlation between the penetration of a foreign body into the gastrointestinal tract and the appearance of symptoms. Note a different period of time, from several months to several years [6].

The penetration of foreign bodies into the gastrointestinal tract rarely leads to complications like perforation and is released spontaneously after some time with a fecal mass. Rarely, it may pass quietly to other places of the abdomen. The indication for the surgical intervention exists for patients with obvious symptomatology the cause of which is the foreign body or it can be easily removed during another not related operation.

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2. Balch CM, Silver D. Foreign bodies in the appendix. Report of eight cases and review of the literature. Arch Surg 1971 Jan;102(1):14–20.   [Pubmed]    
3. Toyonaga T, Shinohara M, Miyatake E, et al. Penetration of the duodenum by an ingested needle with migration to the pancreas: Report of a case. Surg Today. 2001;31(1):68–71.   [CrossRef]   [Pubmed]    
4. Ashby BS, Hunter-Craig ID. Foreign-body perforations of the gut. Br J Surg 1967 May;54(5):382–4.   [Pubmed]    
5. Harjai MM, Gill M, Singh Y, Sharma A. Intra-abdominal needles: An enigma (a report of two cases). Int Surg 2000 Apr–Jun;85(2):130–2.   [Pubmed]    
6. Chan KW. An unusual case of foreign body in the anterior abdominal wall. J Clin Med Res 2010 Mar 20;2(2):93–5.   [CrossRef]   [Pubmed]    
7. Quantz MA, Brown R. Late presentation of an intra-abdominal foreign body. Can J Surg 1997 Aug;40(4):305–7.   [Pubmed]