Truth or dare: a party game as an atypical cause for acute pancreatitis

RB Usta Erdoğan¹, G Gerçel¹, SG Bozbeyoğlu², F Ersoy¹, Ç Ulukaya Durakbaşa¹

¹Istanbul Medeniyet University Faculty of Medicine, Goztepe, Prof. Dr. Suleyman Yalcın City Hospital, Department of Pediatric Surgery
²Istanbul Medeniyet University Faculty of Medicine, Goztepe, Prof. Dr. Suleyman Yalcın City Hospital, Department of Radiology

Introduction: This report presents a rare case of acute pancreatitis caused by an atypical gastroduodenal bezoar.

Case Presentation: A 14-year-old male was admitted to the emergency department with complaints of abdominal pain and vomiting persisting for two days. He had a previous diagnosis of attention deficit hyperactivity disorder and ingested pieces of a T-shirt while playing “truth or dare” with his friends two days before presentation. Physical examination showed generalized abdominal tenderness, most prominent in the epigastric region. Laboratory tests revealed a leukocyte count of 7.800 U/L (4-10³), C-reactive protein 117,2 mg/L (0-5), amylase 2.165 U/L (28-100), and lipase 2.184 U/L (13-60); bilirubin levels were within normal limits. Plain abdominal radiography revealed multiple radiopaque foreign bodies in the epigastric region. Ultrasonography showed diffuse free abdominal fluid. Computed tomography demonstrated the foreign body extending from the stomach to the second part of the duodenum, along with findings consistent with acute interstitial pancreatitis. A large foreign body filling the stomach was detected by upper GI endoscopy, which could not be removed using grasping instruments. A laparotomy was undertaken and by gastrotomy, multiple fragmented shoe components were removed from the stomach and duodenum. Perioperative fluoroscopy confirmed free passage of contrast through distal bowel. Amylase and lipase levels returned to normal on postoperative day four. Oral feeding was initiated on the third day and he was discharged on day five. The patient was referred to pediatric psychiatry outpatient clinics

Conclusion: In childhood, the most common etiologies of acute pancreatitis include drugs, infections, trauma, and anatomical abnormalities. Acute pancreatitis secondary to a bezoar, however, is an extremely rare condition. This case highlights that foreign bodies located in the gastroduodenal region can lead to pancreatitis by obstructing pancreatic outflow and timely removal is therapeutic in terms of pancreatitis.

Keywords: Bezoar, acute pancreatitis, foreign body ingestion, child

RB Usta Erdoğan¹, G Gerçel¹, SG Bozbeyoğlu², F Ersoy¹, Ç Ulukaya Durakbaşa¹

¹İstanbul Medeniyet Üniversitesi Tıp Fakültesi, Göztepe, Prof. Dr. Süleyman Yalçın Şehir Hastanesi, Çocuk Cerrahisi Anabilim Dalı
²İstanbul Medeniyet Üniversitesi Tıp Fakültesi, Göztepe, Prof. Dr. Süleyman Yalçın Şehir Hastanesi, Radyoloji Anabilim Dalı

Anahtar Kelimeler: