Pyloromyotomy-assisted extraction of a neglected giant duodenal spoon complicated by delayed adhesive small bowel obstruction: a case report

Abstract

Intentional ingestion of long gastrointestinal foreign bodies is uncommon in adults. Giant spoon impaction in the duodenum is exceptionally rare and usually requires surgery. A 28-year-old man intentionally ingested an 18-cm metallic spoon. Computed tomography demonstrated impaction in the second part of the duodenum. After initially refusing surgery, repeat imaging suggested extra-luminal extension. Laparotomy with complete Kocher mobilization enabled extraction through a pyloromyotomy, avoiding duodenotomy, followed by Heineke–Mikulicz pyloroplasty. He was discharged on postoperative day seven. Two and a half months later, he developed adhesive small bowel obstruction requiring adhesiolysis, with an uneventful recovery. Pyloromyotomy-assisted extraction is a feasible alternative for selected giant duodenal foreign bodies when endoscopic retrieval is not possible. This case also emphasizes the need for long-term follow-up because delayed adhesive small bowel obstruction may occur after laparotomy.