title: Female Adolescent Presenting With Abdominal Pain: Accidental Wire Bristle Ingestion Leading to Colonic Perforation.
abstract: BACKGROUND
  Abdominal pain in female adolescents is a common presentation to both the emergency department and the outpatient pediatric clinic. The broad differential diagnosis for abdominal pain requires a high index of suspicion to make an accurate diagnosis of foreign body ingestion as the etiology. Foreign body ingestion occurs in all age groups, but sequelae of gastrointestinal tract perforation in children are rare. Treatment for perforation requires consultation of the pediatric general surgeon. Clinicians should take care to not overlook subtle imaging findings or dietary/exposure history, even in the context of a patient with known history of abdominal pain.
  We report the accidental ingestion of a wire bristle from a grill cleaning brush by a female adolescent. The patient, previously treated and seen for constipation and irritable bowel syndrome in the outpatient gastroenterology clinic, was referred to the emergency department after identification of a foreign body on abdominal radiography. Emergency department physicians discovered the history of grilling and consumption of grilled food, facilitating diagnosis of a wire bristle as the foreign body. The metallic foreign body had migrated to the colon, where it perforated and lodged into the abdominal wall, causing acute, focal symptoms. Observation in the hospital with pain control and infection management allowed for elective laparoscopy. The surgical team removed the object with minimal morbidity and avoided laparotomy.
  
  
  CONCLUSIONS
  Reports of unintended ingestion of wire bristles have been increasingly reported in the literature; however, most focus on injury to the upper airway or upper digestive tract and subsequent endoscopic or laryngoscopic removal. Most reports detail injury in adult patients, pediatric case reports with digestive tract injury are uncommon, and foreign body removal after lower digestive tract injury in children from a wire bristle has not been reported. We caution pediatric emergency medicine and ambulatory providers to consider such an ingestion and perforation in the differential diagnosis of acute-onset, focal, and localizable abdominal pain in children.
authors.affiliation: From the Departments of *Pediatrics, †Radiology, and ‡Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE.
authors.forename: Matthew
authors.initials: M
authors.lastname: Di Guglielmo
authors.forename: Jillian
authors.initials: J
authors.lastname: Savage
authors.forename: Sharon
authors.initials: S
authors.lastname: Gould
authors.forename: Stephen
authors.initials: S
authors.lastname: Murphy
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis; D034861:Abdominal Wall / Q000473:pathology* / Q000601:surgery; D000293:Adolescent; D003106:Colon / Q000293:injuries* / Q000473:pathology / Q000601:surgery; D003297:Cooking and Eating Utensils; D003937:Diagnosis, Differential; D004435:Eating; D004636:Emergency Service, Hospital; D005260:Female; D005547:Foreign Bodies / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D041981:Gastrointestinal Tract / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D006801:Humans; D007416:Intestinal Perforation / Q000150:complications* / Q000601:surgery; D010535:Laparoscopy / Q000379:methods; D011859:Radiography; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome