Imaging revealed the wire and helped clinicians make the diagnosis. The case highlights the importance of promptly moving forward with appropriate treatment when imaging reveals a radiolucent object in the appendix, the authors wrote.
Computed tomography (CT) scan shows a 2.7-cm linear object in the girl's terminal ileum. All images courtesy of Sacks et al. Licensed under CC BY-NC 4.0
"Braces are a common phase in children and young adults, so it's possible to conceive the idea that bands, brackets, or wires may become broken or dislodged and ingested, but they have never been reported to cause appendicitis," wrote the group, led by Dr. Marla Sacks from Loma Linda University Children's Hospital in Loma Linda, CA (J Pediatr Surg Case Rep, Vol. 71, 101909).
After three days of abdominal pain, the 11-year-old girl was taken to a hospital for evaluation. The child, who had no past medical history, was transferred to another hospital for suspicion of appendicitis.
Her pain was initially in the periumbilical region and then extended to her right lower quadrant and back. She experienced nausea but did not vomit or have diarrhea or a fever. Two days prior to going to the hospital, she was seen by her pediatrician but was sent home. The girl was taken to the emergency room because her pain had worsened and she lost her appetite, the authors wrote.
During an exam, clinicians determined that her vital signs were normal and her labs were unremarkable. However, a noncontrast CT scan revealed a 2.7-cm, radiopaque, linear object in her terminal ileum. The girl denied swallowing any foreign objects.
Arrow indicates where the orthodontic wire perforated the girl's terminal ileum adjacent to her appendix.
The child was then admitted to the hospital, and a laparoscopy was scheduled for the next day. During the procedure, clinicians discovered that she had an inflamed and dilated appendix adjacent to the terminal ileum. They found that a green-gray metallic wire had punctured the terminal ileum in a "pinpoint fashion."
The team extracted the wire without the need for intestinal repair and removed her appendix. The girl was discharged the day after the procedure and needed no subsequent care, the authors wrote.
The gray-black, semiflexible orthodontic wire.
Importance of cause
Appendicitis is one of the most common diseases in children, affecting approximately 70,000 children in the U.S. every year. However, pediatric cases of appendicitis caused by foreign bodies are rare.
Only 21 cases of appendicitis caused by foreign bodies were reported in 2020. During the past 80 years, there have only been 34 reported cases, and none of the foreign bodies were dental-related objects, according to the authors.
Though the symptoms of the condition were in line with the diagnosis, the root cause of appendicitis in this case is unique in that the irritator, an orthodontic wire, caused the inflammation. Prompt management is important because it decreases morbidity and prevents prolonged hospital stays, the authors wrote.
"While appendicitis is a common disease, foreign bodies should be considered when imaging shows a radiolucent object in the appendix," Sacks and colleagues concluded.
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