April 1993, Volume 43, Issue 4

Case Reports

ACUTE INTESTINAL OBSTRUCTION DUE TO HEN’S EGG

Syed Adam Shah  ( Siraj Medical Complex, Dera Ismail Khan (Punjab). )

Acute organic intestinal obstruction usually invol­ves the small intestine, particularly the ileum. Major inciting causes are external hernia and postoperative adhesions. Less common causes are gall stones, neoplasms, granulomatous processes, intussusception, volvulos, internal hernia and foreign bodies1-4. An un­usual case of intestinal obstruction due to ingestion of hen’s egg is reported.

CASE REPORT

A fifty year old male was admitted with complaints of abdominal pain and vomiting for the last 24 hours. On examination his temperature was 36.7°C, pulse 80/mm and the blood pressure 100/75. Abdomen was centrally distended and the bowel sounds were hyperpersistaltic. Laboratory examination showed a haemoglobin of 14.0 gm/dl, WBC count was 10,500/cmm. Serum electrolytes, blood urea, liver function and urine examination were normal. X-ray KUB showed multiple fluid levels in the small bowel. There was no history of previous operation. Clinically the diagnosis of internal herniation was made. After decompression (passing the nasogastric tube) and rehydration, the patient underwent laparatomy under general anaesthesia. The abdomen was opened through midline incision. On exploration small bowel was found distendedwith avery mobile mass about the size of an egg palpable in the terminal ileum. The mass was soft in consistency. It was delivered through enterotomy. The enterotomy was closed in two layers transversely and closure of the abdomen was carried out using proline. The mass was egg shaped having dark brown colour. During palpation by one of the members of the surgical team the mass got ruptured. The fluid material which came out was foul smelling and yellowish white in colour like the one present in the rotten egg. When the patient came out of general anaesthesia he narrated that three days before his symptoms started he slaughtered a hen and found multiple eggs present in different stages of maturation in the abdominal cavity. The patient swallowed one of the unripe egg which was about the size of a big grape. There was no other relevant history. The patient recovered without any complication and went home on seventh day.

DISCUSSION

Foreign bodies are one of the causes of acute intestinal obstruction. In the present case the egg which was found in the ileum was almost like a fully mature egg except that it was soft. The egg of this much size cannot be swallowed. It seems that after passing through the pyloric sphincter and entering the small intestine, it got stuck in the ileum (2 feet from ileocaecal valve) which is the narrowest part of the small gut. The possible causes of enlargement of the egg include favourable conditions within the G.I.T. where it really matured; or the rotten egg increased in size due to presence of the viscous material and gas within it.

REFERENCES

1. Mocha, P. Jr. Small intestinal obstruction. Surg. din. North Am., 1987;67:597-620
2. Rains. A.J.H. and dapper, W.M. Bailey and Love. Short practice olsut-gety. 13th cd. London, Lewis, 1965, pp.961-7.
3. Hamaloglu, 13. and Yildiz, K. Lipoma of lam causing intutsusception. 3. Pat Med. Assoc.. 40: 161-2.
4. Schroeder, S.A., Krupp, M.A., Tierncy, LM. and McPhee, 5.3. current medical diagnosis and treatment. Norwalk, Appleton and Langes, 1989, pp. 377-8.

Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: