Six months silent: A rare case of delayed duodenal perforation and pancreatitis following intentional foreign body ingestion

Delayed duodenal perforation and pancreatitis following foreign body ingestion

Abstract

Foreign body ingestion is usually self-limited, with most objects passing spontaneously without complications. Rarely, however, retained foreign bodies may cause severe and delayed sequelae. We report the case of a 56-year-old incarcerated man who developed duodenal perforation, an enterocutaneous fistula, and secondary pancreatitis six months after intentional ingestion of a plastic spork. Imaging demonstrated a foreign body penetrating the second portion of the duodenum and extending into the abdominal wall. Definitive surgical management was delayed because of psychiatric illness and repeated refusal of care. After eventual consent was obtained, the patient underwent exploratory laparotomy with foreign body removal, duodenal repair, pyloric exclusion, and gastrointestinal diversion. Despite postoperative complications, he recovered with multidisciplinary management. This case highlights the potential for delayed, life-threatening complications from retained foreign bodies and underscores the ethical and clinical challenges encountered in patients with psychiatric comorbidities.