RESUMO
Foreign body ingestion is an infrequent cause of small bowel obstruction and, rarely, perforation. It is a common occurrence among pediatric patients, mentally impaired and the edentulous elderly population majority of which will pass through the gastrointestinal tract uneventfully. The likelihood of complications such as perforation, bleeding or fistula formation increases markedly particularly for sharp, stiff, and elongated objects (i.e. toothpicks, meat bones, pins, and razor blades). Diagnosis can be difficult as frequently patients are incognizant of the nature and time of ingestion. Imaging is commonly non-specific as well. We present an unusual case of a 65-year-old male who had an ileal perforation secondary to a coconut leaf midrib skewer initially presenting as small bowel obstruction. Intraoperatively, adhesions were seen in the ileum with note of the foreign body perforating two bowel loops that was not identified in preoperative imaging. This case highlights the importance of considering atypical causes of small bowel obstruction even in the background of previous surgery. Finally, early recognition, accurate diagnosis, and timely intervention are essential to improve patient outcomes and decrease mortality in such cases.
RESUMO
INTRODUCTION: Economic growth and developments in health care has increased life expectancy leading to the rise of the elderly population in the Philippines, underscoring the need for more comprehensive approaches in the care of older persons at the local level. This study describes the existing health programs for older persons within the socio-cultural and institutional frameworks and identifies opportunities for development.METHODS: Focus group discussions of key informants and stakeholders were conducted in Malaybalay, Bukidnon last April 2009 to identify the socio-cultural aspects, existing programs, local government support, and challenges for health care of older persons. Triangulation of results was done to determine areas for consideration integrating care for older persons within the public health system.RESULTS: Elderly want to be independent and not be a burden to their families. The good implementation and adoption of national policies on social welfare of senior citizens and the many health activities mentioned offered by the Municipal Health Office for senior citizens is contrary to the senior citizens concern of not being able to avail of such health program. The barriers indicated were physical incapacity, geographic, lack of family and community support, and financial. Each senior citizen gets a monthly pension of Php 200 from the government. The main ailments of senior citizens were cardiovascular diseases, diabetes, eye, hearing & respiratory problems, degenerative diseases including osteoporosis and Alzheimer's disease. Elderly Filipinos were open to the possibility of being cared for by non-family community members. The Senior Citizens group recommended that they be given their own community group.RECOMMENDATION: Health care for older persons can be improved within the framework of existing community structures. Integration of care for older persons within the public health system requires holistic approaches, financial support strategies, capacity enhancement for the health workforce, continuing dialogue and care, and community involvement.
