An unusual cause of right upper quadrant pain: Gastric perforation from a foreign body diagnosed with point-of-care ultrasound (PoCUS) in the emergency department: A case report

Background

Foreign body (FB) ingestion is a common presentation in the emergency department (ED). Point-of-care ultrasound (PoCUS) is useful for detecting ingested foreign bodies in pediatrics. However, its utility for diagnosing FB ingestions in adult patients has not been well described.

Case report

We present a case of a 52-year-old female patient who presented to our ED with right upper abdominal pain. A PoCUS revealed a long echogenic structure between the gastric pylorus and the gallbladder wall. The appearance raised suspicion for a foreign body perforating through the gastric wall. A CT scan confirmed the diagnosis of a fishbone perforating through the gastric wall. The patient underwent exploratory laparoscopic surgery that confirmed the perforation. The fishbone was removed endoscopically, and the patient made an unremarkable recovery.

Why should an emergency physician be aware of this?

Foreign body ingestion is an important cause of abdominal pain in the ED and can lead to significant morbidity if there is a delay in diagnosis. Some patients may not be aware that they ingested a foreign body. Identification of an abnormal echogenic structure in the abdomen at the site of tenderness should prompt further investigation and consultation.