Intestinal Perforation by a Foreign Body Mimicking Appendicular Syndrome: A Case Report

Abstract: Background: Swallowing a foreign body is a common occurrence in emergency digestive medicine; yet, when the object migrates into the small intestine and causes perforation, the resulting complication is both rare and diagnostically challenging. This report describes a case in which a metallic fragment — most likely of dental origin — perforated the ileum and presented with clinical features that were, at first, virtually indistinguishable from acute appendicitis. Case Report: A 62-year-old man with no notable medical background attended the emergency department complaining of right iliac fossa (RIF) pain persisting over three days, accompanied by a biological inflammatory response. Contrast-enhanced CT of the abdomen identified a linear metallic density within an ileal segment, along with focal mural thickening (8 mm), surrounding mesenteric fat infiltration, and extra-luminal air consistent with a contained bowel perforation. The case was discussed at a multidisciplinary surgical meeting, following which emergency laparotomy was undertaken. Intraoperatively, localized peritonitis was observed alongside a full-thickness ileal perforation situated roughly 200 cm proximal to the ileocaecal junction. The causative foreign body was removed, the defect was repaired using a double-layer primary closure, and thorough peritoneal irrigation was performed. Recovery was straightforward and without complications. Conclusion: When a patient presents with acute right iliac fossa pain that lacks a clear explanation, intestinal perforation from an ingested foreign body should be considered, especially when the history reveals a recent dental procedure. Contrast-enhanced CT remains the imaging tool of choice in this context, and timely operative intervention is the cornerstone of management.