C-ARM can assist us to find Small Metal foreign bodies swallowed and entrapped in GI tract

Introduction:Ingestion of foreign body is a common behavior among pediatric population. The majority of the foreign bodies transit through gastrointestinal tract without causing any complication. However, it has been reports of perforation, abscess formation and obstruction in the GI tract. Case Presentation:A 2 year and 4-month old girl presented to our clinic with complaint of right lower quadrant abdominal pain. Pain started a day before presentation and had a vague and colicky nature. No other systemic or GI related symptoms were reported. She initially was visited in an outside facility and plain radiographs were obtained and a foreign body was seen in her RLQ abdomen. In her physicalexamination, she had mild right lower quadrant tenderness with signs of peritoneal irritation. Considering the ingested foreign body and her clinical situation, she was prepped for operation. By CARM assistance we found in the base of appendix and appendectomy was performed. Appendix was inflamed and congested and had a bulge near it s tip. Appendix examination at bedside revealed a black 8mm screw and two small pieces of appendicolith.Discussion:Interestingly, first case of appendectomy was on a child who ingested a metal sewing pin and developed acute perforated appendicitis. After then in 1912 Eames reported a 15 year old boy with right lower quadrant abdominal pain and tenderness, having a needle in the appendix. Since then, it has been reports of needles, shotgun pellets, bird shots, hazelnut, hair, sand, stones and screws which were dislodged in the appendix. It is recommended that objects stopped traversing the RLQ of abdomen for at least 72 hours, should be removed by colonoscopy or surgery. Conclusion:In general, if the object dislodges in the appendix or even stops progressing, an appendectomy is indicated to prevent further complications even if there are no symptoms. In the cases, we could not find the small metal foreign body; there is a possibility that we can use theC-ARM radiographic device for finding it.