TY - JOUR T1 - Duodenal perforation due to multiple foreign bodies: consideration for operative approach and surgical repair JF - Trauma Surgery & Acute Care Open JO - Trauma Surg Acute Care Open DO - 10.1136/tsaco-2022-001063 VL - 7 IS - 1 SP - e001063 AU - Kyla Wright AU - Charlotte M Rajasingh AU - Sue J Fu AU - Jamie Tung AU - Brendan C Visser AU - Lisa M Knowlton Y1 - 2022/12/01 UR - http://tsaco.bmj.com/content/7/1/e001063.abstract N2 - A young patient with developmental delay and recurrent foreign body ingestion presented to the emergency department with abdominal pain, nausea, and vomiting after reportedly ingesting unidentified foreign objects 2 days previously. The patient was afebrile and slightly tachycardic, but hemodynamically stable. Labs were notable for white blood cell count of 19×109/L. CT of the abdomen showed multiple foreign bodies in the duodenum and small bowel including a screw (figure 1). The patient was taken to the operating room for foreign body removal, endoscopy, and repair of any bowel injuries.Figure 1 CT of the abdomen demonstrating multiple foreign bodies in the duodenum and proximal small bowel, with evidence of perforation.We made an upper midline laparotomy incision. In D1, there were several large palpable objects. These were milked back through the pylorus and removed via a gastrotomy on the anterior stomach wall. They were too large to safely remove by upper endoscopy. One was a plastic object with a screw inside of it. Others were folded up plastic and unidentifiable inorganic material.We then evaluated the small bowel and remainder of the duodenum. The mid small bowel was adherent to D3/D4. We finger fractured the bowel free and identified one 2 cm … ER -