Foreign Body in the Fallopian Tube – Case Report

Abstract

Background

Foreign bodies in the female pelvic cavity are rare cases that demand expert imaging skills to interpret and evaluate the correct anatomic location, shape and consistency. More often than not these foreign bodies have transmigrated from the utero-vaginal cavity. After literature research we have found several instances of contraceptive devices, tubal ligation clips, intrauterine devices, vaginal rings, etc. However, the traumatic, extracorporeal and intestinal perforation origin should not be overlooked.

Case presentation

The 59-year-old female patient presents to the surgical consult clinic with the complaints of pelvic region pain for over three months. After several other specialties consults a radio-opaque foreign body was found in the pelvic cavity on a pelvic x-ray. The patient refers that during an MRI examination the machine had an emergency stop. According to the technician this could happen when a ferro-magnetic body is encountered. She denies having inserted any intrauterine device, nor other gynaecologic procedures. Also, she denies having knowingly ingested any foreign bony or metallic body. We suggested a CT scan, which shows a dense, fragmented foreign body of an approximate 4cm length in the intraperitoneal pelvic cavity, in close contact to the fallopian tube. After a median inferior laparotomy. This bipartite, rusty, metallic foreign body had perforated the fallopian tube and was partially intraperitoneally enveloped by the greater omentum. We proceeded with the foreign body extirpation and a cuneiform oophorectomy of the same side due to an ovarian cyst. The patient had a full recovery.

Discussion

In our literature review we have found only a small number of instances of intraperitoneal foreign bodies of unknown origin. Our patient denied having ingested metallic or bony materials, also denied any gynaecologic procedures or having inserted intrauterine devices. Transmigration of metallic uterine devices is a well-known fact. Thus, patient history does not offer much information on this case. Imaging studies and an expert evaluation of the foreign body location was a determinant factor for the surgical treatment strategy.

Conclusion

Due to the rarity of such cases of non-ingested intraperitoneal foreign bodies, this patient presented a diagnostic and therapeutic dilemma. After verifying the presence of the opaque body in the pelvic cavity, in close relationship to the Fallopian tube, an open surgical approach was concluded to be the most feasible option, taking in consideration the possibility of intestinal integrity compromise.

Keywords: General Surgery, Foreign Body, Fallopian Tube, Intraperitoneal, Perforation.

DOI: 10.7176/JEP/14-16-03

Publication date:June 30^th 2023