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Case Report
A caecal perforation from foreign body ingestion in a child with autistic spectrum disorder
1 Surgical Principle House Officer, Department of General Surgery, Ipswich Hospital, Ipswich, Queensland, Australia
2 Surgical Registrar, Department of General Surgery, Ipswich Hospital, Ipswich, Queensland, Australia
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Tzu-Yi Chuang
7/141 Station Road, Sunnybank, Queensland 4109,
Australia
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Article ID: 100968Z01TC2018
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Chuang TY, Samuel S, Malik H. A caecal perforation from foreign body ingestion in a child with autistic spectrum disorder. Int J Case Rep Images 2018;9:100968Z01TC2018.ABSTRACT
Foreign body ingestion is a common medical issue. However, quite often the diagnosis of foreign body ingestion can be a challenge as clinical presentation is variable, often with non-specific symptoms. It is reported that 80- 90% of ingested foreign bodies can pass through the gastrointestinal tract without any clinical sequalae; rarely, 1%, cause bowel perforation. This report presents the case of a 13-year-old boy with autistic spectrum disorder brought in by his parents with undifferentiated abdominal pain and non-specific symptoms including recent flu-like symptoms, generalised weakness, and lethargy. It was difficult to obtain a thorough history and examination due to his developmental disorder. Diagnostic laparoscopy was subsequently conducted and an unexpected finding of a caecal perforation from an ingested metal wire was noted. Primary closure of the caecal perforation was performed post metal wire removal. The patient recovered well with no post-operative complications. As clinicians, we should have a high index of suspicion for foreign body induced viscus perforation when patients present with atypical abdominal pain, especially in those with paediatric developmental disorders such as autism. Patients with autism often increase the difficulty of clinical diagnosis due to poor history taking and a challenging physical examination. Overall, an emergency diagnostic laparoscopy is recommended if the patient has any suspicion of an acute abdomen.
Keywords: Autism, Caecal perforation, Foreign body
SUPPORTING INFORMATION
Author Contributions
Tzu-Yi Chuang - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Sijo Samuel - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Hassan Malik - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this case report.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2018 Tzu-Yi Chuang et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
