A Case of Duodenal Perforation due to Ingested Neem Twigs Mimicking Acalculous Cholecystitis

ABSTRACT

Introduction: Most foreign bodies in the G.I tract areasymptomatic and probably pass spontaneously in stool. Fewmay cause complications and require interventions. Diagnosiscan be a challenge in certain cases. We present a case in whichthe ingestion of a Neem Twig caused duodenal perforationmimicking Acalculous Cholecystitis.Case report A 63-year-old lady visited emergency withacute abdominal pain of 2 day history. Computed tomography(CT) showed mildly thickened Gall bladder with loculatedpericholecystic fluid collection which is extending intosubcapsular region of segment III of liver. A LaparoscopicCholecystectomy was planned in view of Acalculouscholecystitis. Intraoperative, an Omental phlegmon guardinga Neem (Azadirachta indica) twig which perforated out ofduodenum was found. Laparoscopy was converted to an openmidline Laparotomy and graham’s Omental patch repair ofduodenum perforation was done.Conclusion: The patient has been doing well since theoperation. She gave history of swallowing the Neem Twig6 Months prior to this surgery. Many a times open surgicalapproach would give a satisfactory search rather thanLaparoscopy