The symptoms: The man went to the emergency room because he had a sharp pain in his lower-right abdomen.
Appendicitis can be dangerous because it can cause the appendix to burst and release bacteria from the bowels into the abdominal cavity, thereby infecting the cavity's lining. This infection, called peritonitis, can spread to the bloodstream and cause the life-threatening condition sepsis, which kicks the immune system into overdrive.
The report's authors did not include details about the man's treatment after this examination. But eight months later, he was still in pain and returned to the hospital for further evaluation, they noted.
At this second visit, doctors performed an abdominal X-ray and found a round object near the upper right of the man's pelvis. It measured about an inch (2.5 centimeters) long and a little over an inch (3 cm) wide.
The treatment: Surgeons performed a laparoscopic appendectomy, which uses small incisions in the abdomen to insert instruments for removing the appendix. Inside the appendix was a hardened mass of fecal matter, called a fecaloma, which surrounded a long bone.
The appendix (orange) is a small, thin pouch of tissue attached to the colon. (Image credit: SEBASTIAN KAULITZKI/SCIENCE PHOTO LIBRARY via Getty Images)
What makes the case unique: It's relatively uncommon for people to accidentally swallow something indigestible and then require a medical visit for it. In the United States annually, about 120,000 people — roughly 90% of whom are children — are treated for ingesting foreign objects, and most of the objects are swallowed accidentally. Most commonly, the adults requiring treatment have ingested jewelry, while children are more likely to swallow coins, toys and batteries.
Swallowed foreign bodies rarely affect the appendix. Whether they enter the organ depends on the size of the opening into the appendix where it connects to the colon (which can vary between individuals), the dimensions of the ingested object, and the appendix's position in the body at the time. These objects cause approximately 0.005% cases of appendicitis, according to the man's case report. Such items recovered by surgeons through appendectomies include pieces of coal, nails, bits of enamel and glass, shells, dental crowns and bullets.
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They added that their patient was the first record in the scientific literature of a sizable bone lingering inside an appendix for more than a decade without causing significant inflammation. His pain was likely caused by physical shifting of the hard mass. His experience presented "a unique clinical picture," the doctors wrote.
For more intriguing medical cases, check out our Diagnostic Dilemma archives.
Can you guess the diagnosis in these strange medical cases? Find out with our diagnostic dilemma quiz!
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