An unusual cause of large bowel perforation: ingestion of a clam valve

Excerpt

A 77-year-old woman presented to emergency complaining of a severe and diffuse abdominal pain associated with a sensation of distension and constipation; at physical examination, the abdomen was intractable suggesting a condition of acute abdomen. Contrast-enhanced computed tomography (CT) showed diverticular disease of the sigma. The wall of its proximal tract was thickened and hyperemic, while distally a high-density (about 1890 HU) foreign body was evident, surrounded by an extra-luminal fluid collection with air bubbles, suggestive of abscess. Distension of proximal loops of large bowel was evident too. CT images were compatible with sigma perforation own to obstruction caused by the presence of the foreign body. To better evaluate and characterize its nature, multiplanar reformation (MPR) and volume rendering (VR) reconstructions were obtained. In MPR (Fig. 1a–c), the foreign body has a rounded, concave and “C” shape and measured approximately 25 × 20 mm (LLxCC). VR images (Fig. 1d–f) were, in this case, more suggestive, revealing almost with certainty the nature of the foreign body: a clam valve. Surgery confirmed the diagnosis.

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