Pellets in the appendix !
An 8-year old hyperactive boy was admitted in hospital after having been found to have elevated blood levels ranging from 17.4 to 27.4 ug per decilitre (reference range <10) over a period of 2years .an abdominal radiograph revealed small ,hyper dense foci in the rt.lower quadrant.the entire family reported that they are geese daily that was killed with lead pellets from the short gun.and children reported that they were eating pellets as a part of the game to make them disappear.the patient and siblings underwent bowel washout.A follow up radiograph of patient showed that there were still pellets present in the gastrointestinal tract .in either the cecum or the appendix.laproscopic appendectomy was performed .the appendix weighed 27.5 grams(normal weight 4-5g) measured 55mm lean goth and had an average diameter of 7mm with a wall thickness of 2 mm .a total of 57 lead pellets were removed from the lumen . Microscopical examination of appendix showed minor changes with a focus of submucosal calcification and fibrosis.No acute inflammation was observed.
