Duodenal and inferior vena cava perforation due to a rosemary branch ingestion: a Case Report

Duodenal and inferior vena cava perforation due to a rosemary branch ingestion: a Case Report

Simone Gianazza¹, Davide Inversini¹, Lorenzo Latham², Sabrina Garbarino¹, Matteo Zanchetta¹, Marika Morabito¹, Natalia Palamara¹, Giuseppe Ietto¹ and Giulio Carcano¹

¹General, Emergency and Transplant Surgery Department, ASST-Settelaghi, University of Insubria, 21100 Varese, Italy; ²UO Chirurgia Generale, Ospedale SacraFamiglia – Fatebenefratelli, 22036 Erba, Italy

Introduction: Foreign  body  (FB)  ingestion  is  frequently  observed  in  surgical  and endoscopic practice. They are often removed from the body cavities without causing any severe complications but occasionally they lead to serious damages. We report a case of a  rosemary  branch  ingestion  causing  a  duodenal  and  Inferior  Vena  Cava (IVC) perforation.

Case  Presentation:  A 61 year-old man was admitted in ER with abdominal pain, vomiting  and  with  a  single  episode  of  melaena.  Vital  parameters  were  stable. The abdomen was mildly distended but tender. Computed tomography (CT) scan revealed a foreign body in the second part of duodenum, passing through it, reaching and perforating the Inferior Vena Cava (IVC). An urgent Esophagogastroduodenoscopy (EGDS) confirmed the presence of a rosemary branch passing through the duodenum in correspondence of the lower duodenal knee. An emergency surgery with a median xifopubic laparotomy was performed.  The foreign body removed firstly from the duodenum, then from IVC. No complication were observed in the postoperative period.

Discussion: This case peculiarity was the paucisymptomatic presentation related to the severe lesion to the vessels and the bowel. Laparotomic approach was chosen to permit a secure and effective bleeding control.  Probably the lack of symptoms, was due to the presence of an extended fibrotic reaction around the rosemary branch.

Conclusion:  Duodenal  perforation  and  large  vessels  lesions  due  to  foreign  body ingestion are rare conditions that can lead to severe complications. Not withstanding the utilization of Computed Tomography (CT) scans and endoscopic procedures, the surgical management  of  bowel  perforation  induced  by  foreign  bodies  continues  to  present  a formidable challenge. The optimal course of acting to ensure a favorable clinical outcome frequently relies upon the surgical approach adopted by the operating surgeon.

Keywords: Foreign  body,  case  report,  duodenal  perforation,  inferior  vena  cava perforation

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Simone Gianazza, Davide Inversini, Lorenzo Latham, Sabrina Garbarino, Matteo Zanchetta, Marika Morabito, Natalia Palamara, Giuseppe Ietto, Giulio Carcano. Duodenal and inferior vena cava perforation due to a rosemary branch ingestion: a Case Report. International Journal of Case Reports, 2023, 7:294. DOI: 10.28933/IJCR-2023-05-2305sg

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