McDonald, Rusnak: Plastic bread-bag clips: the saga continues< [CMAJ

Plastic bread-bag clips: the saga continues

CMAJ 2000;163(1):16

We read with interest the recent report of plastic bread-bag clips in the gastrointestinal tract [Research].¹ We were recently consulted regarding a patient whose small bowel was ultimately found to have been perforated owing to an impacted plastic bread-bag clip.

The patient, a 39-year-old man, had been experiencing intermittent episodes of colicky abdominal pain for about 5 years. He had previously been admitted to hospital with signs and symptoms consistent with a small bowel obstruction. He had undergone several investigations, including CT scans and a small bowel follow-through, but no cause was identified.

He presented at our hospital with severe pain and a recent onset of nausea and vomiting. This followed several weeks of increasing crampy pain, associated with at least 1 episode of rectal bleeding. He was admitted to the GI service and over the next 36 hours developed signs of peritonitis, for which the surgical service was consulted. In the meantime, he had undergone both an ultrasound and a CT scan, which showed a small amount of free fluid but nothing else.

He underwent a laparotomy, and the clip was found in the distal small bowel, where it appeared to have attached itself and slowly eroded through the wall, as described by Ken Newell and colleagues.¹ He underwent a resection and primary anastomosis, from which he has recovered well. Unfortunately, the "best before" date was no longer visible on the clip.

In contrast to most of the patients in the study by Newell and colleagues,¹ this patient was young and had his own teeth. However, he is a single parent of young, active children and said that he often eats in a rush and does not chew his food well.

The findings in this case support the authors' recommendation that the clips be made of a radiopaque material to allow early identification of the foreign body.

Susan McDonald
General surgery resident
sem061@yahoo.com
Con Rusnak
General surgeon
Capital Health Region
Victoria, BC

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Reference

Newell KJ, Taylor B, Walton JC, Tweedie EJ. Plastic bread-bag clips in the gastrointestinal tract: report of 5 cases and review of the literature. CMAJ 2000;162(4):527-9.