Appendiceal entrapment of an ingested metallic nail in a 10-year-old boy: a case report

Abstract

Foreign body (FB) ingestion is a frequent pediatric concern. While most objects pass spontaneously, a small percentage becomes impacted at anatomical narrowings. The appendix is an exceptionally rare site for FB entrapment, representing approximately 0.05% of cases. A 10-year-old boy presented with a metallic nail ingestion one month prior. He was largely asymptomatic except for mild periumbilical pain. Serial radiographs over 11 days showed the nail stationary in the right lower quadrant, initially suggesting ileocecal valve impaction. After 12 days of failed conservative management, exploratory laparotomy and intraoperative C-arm imaging localized the nail within a non-inflamed appendix. An appendectomy was performed, leading to an uneventful recovery. Appendiceal foreign bodies are diagnostically challenging as they may remain dormant or mimic acute appendicitis. Sharp objects, such as nails, pose a high risk of perforation (up to 75% in some series). Standard imaging often fails to differentiate between an object in the terminal ileum versus the appendiceal lumen. Given the risks of delayed inflammation or perforation, prophylactic appendectomy is the recommended management for stationary appendiceal FBs. A radiopaque foreign body that remains stationary in the right lower quadrant on serial imaging should raise clinical suspicion of appendiceal entrapment. Early surgical intervention is vital to prevent complications, even in asymptomatic patients.