Riley D Stewart, MD, MSc, FRCSC, James Ellsmere, MD, MSc, FRCSC. Dalhousie University Division of General Surgery
Introduction: Oropharyngeal and Gastrointestinal (GI) perforations from BBQ brush bristles are being reported in the literature with increasing frequency. Media attention to this problem has increased awareness by the public. Most commonly, BBQ bristles lodged in the GI tract can be removed endoscopically or pass without complication. Rarely, surgical intervention is required for removal of the bristle or drainage of an associated abscess. We report a case of gastric perforation by a BBQ bristle leading to a pancreatic abscess.
Case Report: A 41-year-old male presented to a regional center with epigastric pain and malaise. His medical history included: hypertension, dyslipidemia, GERD, and smoking. His surgical history included: a tonsillectomy, excision of bronchial cleft cyst, and an umbilical hernia repair. On presentation, his laboratory investigations where unremarkable aside from an elevated white blood cell count. Investigations including an abdominal X-rays and an abdominal ultrasound were unremarkable. He was initially treated with a proton pump inhibitor for presumed peptic ulcer disease. He returned to the local emergency room, no better than before. A CT scan was arranged which demonstrated a foreign body at the pylorus consistent with a BBQ bristle and a peripancreatic fluid collection (Figures 1 & 2). A gastroscopy failed to identify the bristle. He was admitted, placed on IV antibiotics and referred to our center. Despite several days of antibiotics prior to arrival, the collection size on repeat CT scan had increased and the patient had ongoing pain. We repeated the endoscopy with a side viewing endoscope. The perforation was identified posteriorly at the pylorus. The bristle had migrated into the peripancreatic space. The perforation was cannulated with a Jagtome. Fluoroscopy was used to confirm the position of a wire in the fluid collection (Figures 3 & 4). Pus was drained from the collection into the stomach by placement of a 5 French pigtail catheter (Figure 5).
The patient was discharged pain free the following day. The patient was asymptomatic at 6 weeks’ follow-up. A repeat CT scan showed resolution of the abscess and safe migration of the bristle and stent out of the GI tract (Figure 6)
Conclusion: To our knowledge, this is the first reported transgastric endoscopic drainage of a peripancreatic abscess caused by a BBQ bristle gastric perforation. This case is a demonstration of the ever-expanding role of therapeutic endoscopy in a surgical practice.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87180
Program Number: P366
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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