An unusual cause of duodenal perforation due to a lollipop stick
A six-year-old girl with no previous history of medical problems or surgery was admitted to the emergency department of our hospital with a two-day history of diffuse abdominal pain, nausea and vomiting. Physical examination of the febrile patient (38.8℃) was unremarkable except for moderate right-upper quadrant abdominal tenderness. Laboratory findings revealed moderately increased white blood cell count (20,710/µL; reference range, 4,000 to 11,000/µL) and C-reactive protein level (6.95 mg/dL; reference range, 0 to 0.3 mg/dL). Hemoglobin, platelet count, total bilirubin, aminotransferases, amylase, lipase, creatinine, and urinalysis were within reference ranges. Chest and plain abdominal X-ray examinations were unremarkable (). Abdominal ultrasonography showed a tubular echogenic structure in the second portion of the duodenum with the possibility of duodenal penetration and adjacent omental fatty infiltration associated with right-side peritonitis (). The computed tomography scan also identified a linear foreign body of about 10 cm with internal air contents in the duodenum (). The patient denied foreign body ingestion.\nConsidering the patient's stable general condition, we chose to perform a laparoscopic examination to assess the status of the perforation site and surrounding tissues. Using an umbilical 5-mm port, two 3-mm ports at the upper midline, and a fourth 5-mm port in the subxiphoid area, we found a lollipop stick perforating the second portion of the duodenum and evidence of peritonitis. The stick was easily discernible and extracted from the duodenal lumen through the perforation (). The biliary tree was undamaged. The perforation was closed in a single layer using 4/0 absorbable monofilament (Monosyn) and later reinforced with an omental patch. The peritoneal cavity was lavaged with saline. We performed intraoperative upper gastrointestinal endoscopy with a pneumatic test and found no evidence of leakage. We inserted a closed drain in the right upper quadrant of the subdiaphragmatic area.\nThe postoperative course was uncomplicated. The patient resumed oral intake on the seventh postoperative day and was discharged from the hospital ten days after surgery.