DR MOHAMMED IRFAN SHEIKH over 5 years ago

Pellets in the Appendix

An 8-year-old hyperactive boy was admitted to the hospital after having been found to have elevated blood lead levels, ranging from 17.4 to 27.4 μg per deciliter (reference range, <10) over a period of 2 years. An abdominal radiograph revealed large numbers of small, hyperdense foci in the right lower quadrant. The entire family reported that they regularly ate geese that were killed with lead pellets from a shotgun, and the children reported that they had been eating the pellets as part of a game to make them disappear. The patient and his siblings underwent bowel washout. A follow-up radiograph of the patient revealed that pellets were still present in the gastrointestinal tract, in either the cecum or the appendix (Panel A). Laparoscopic appendectomy was performed. The appendix weighed 27.5 g (normal weight, 4 to 5 g), measured 55 mm in length, and had an average external diameter of 7 mm with a wall thickness of 2 mm. A total of 57 lead pellets were recovered from the lumen (Panel B). Microscopical examination of the appendix showed minor changes with a focus of submucosal calcification and fibrosis. No acute inflammation was observed.