Pancreatic and biliary obstruction years after retention of a swallowed coin in a duodenal diverticulum: A case report

Ismail, Ibrahim and Mudge, David W (2015) Pancreatic and biliary obstruction years after retention of a swallowed coin in a duodenal diverticulum: A case report. Journal of Medical Case Reports, 9 144: . doi:10.1186/s13256-015-0608-6


Author Ismail, Ibrahim
Mudge, David W
Title Pancreatic and biliary obstruction years after retention of a swallowed coin in a duodenal diverticulum: A case report
Journal name Journal of Medical Case Reports   Check publisher's open access policy
ISSN 1752-1947
Publication date 2015-06-18
Year available 2015
Sub-type Article (original research)
DOI 10.1186/s13256-015-0608-6
Open Access Status DOI
Volume 9
Issue 144
Total pages 4
Place of publication London, United Kingdom
Publisher BioMed Central
Collection year 2016
Language eng
Formatted abstract
Introduction
Congenital duodenal diverticula are a rare anomaly. The discovery of one in association with an ingested foreign body has only been reported on one previous occasion. In this challenging presentation, the presence of the coin led to the correct diagnosis. Patients with congenital duodenal anomalies may present a number of associated abnormalities. Interestingly, after the discovery of his intraluminal duodenal diverticulum, we searched and found that our patient presented a number of associated pathologies, as described in the literature.

Case presentation
Our patient was a 36-year-old man, Caucasian, a kidney transplant recipient who presented with abdominal pain, vomiting and fever after an episode of pancreatitis. Because of a history of behavioral problems associated with intellectual impairment, including a compulsion to swallow coins during childhood, an abdominal radiograph was performed. Surprisingly, the radiograph revealed a radiopaque shadow in the central abdominal area. The findings of the ultrasound examination and computed tomography scan were suggestive of dilated biliary and pancreatic ducts. We performed an endoscopic retrograde cholangiopancreatography, which led to confirmation of the suspected coin above an obstructing intraluminal duodenal diverticulum with associated biliary ductal dilation. Upon retrieval of the coin, it was found to be a 1975 copper two-cent piece out of circulation in Australia for a large number of years.

Conclusions
Foreign body retention in the gastrointestinal tract in an adult could be a sign of underlying mechanical pathology. Intraluminal duodenal diverticulitis can have a varied presentation, including life-threatening complications. Awareness should be raised of the conditions associated with congenital duodenal anomalies in adults, including renal, hepatobiliary and cardiac defects, many of which were present in our case.
Keyword Duodenal diverticulum
Pancreatitis
Foreign body
Endoscopic retrograde
Cholangiopancreatography
Coin
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Medicine Publications
 
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