title: Gastric perforation by a foreign body presenting as a pancreatic pseudotumour.
abstract: BACKGROUND
  Foreign body ingestion rarely causes complications, though it can pose a significant diagnostic challenge. Perforation, particularly of more muscular viscera, can present insidiously with a wide range of differential diagnoses.
  
  
  METHODS
  Here we present a case of 75 year-old woman presenting with chest and epigastric pain. Initial imaging suggested a pancreatic lesion. Despite appropriate treatment she deteriorated clinically, and following urgent laparotomy a duck bone fragment was found to have perforated the lesser curvature of the stomach and embedded within the liver causing subhepatic abscess formation and associated inflammation.
  
  
  CONCLUSIONS
  There are a number of examples of insidious presentations of gastrointestinal perforation. However, we have found only one other case of a perforation presenting as a pancreatic pseudotumour, and ours is the first to have been successfully managed by removal of the foreign body and drainage of the abscess alone.
  
  
  CONCLUSIONS
  A high level of suspicion is required to make the correct diagnosis in cases such as these where the symptoms are not clear-cut. Thorough review and discussion of imaging prior to surgical treatment is essential to prevent unnecessary intervention.
authors.affiliation: Department of Surgery, Northwick Park Hospital, Watford Road, Harrow HA1 3UJ, UK. Electronic address: helen-williams@doctors.org.uk.
authors.forename: Helen E
authors.initials: HE
authors.lastname: Williams
authors.affiliation: Department of Surgery, Northwick Park Hospital, Watford Road, Harrow HA1 3UJ, UK.
authors.forename: Arif A
authors.initials: AA
authors.lastname: Khokhar
authors.affiliation: Department of Surgery, Northwick Park Hospital, Watford Road, Harrow HA1 3UJ, UK.
authors.forename: Maleeha
authors.initials: M
authors.lastname: Rizvi
authors.affiliation: Department of Surgery, Northwick Park Hospital, Watford Road, Harrow HA1 3UJ, UK.
authors.forename: Stuart
authors.initials: S
authors.lastname: Gould
keywords: Foreign body; Perforation