Publication:

Missed intraoperative localisation of an accidentally ingested razor blade in a child with subsequent spontaneous passage: a case report

Accidental ingestion of sharp foreign bodies in children is a pediatric surgical emergency that carries a significant risk of gastrointestinal perforation, hemorrhage, and obstruction. Although the majority of ingested foreign bodies pass spontaneously, sharp metallic objects such as razor blade fragments represent a particularly high-risk category. Failure to localize such objects intraoperatively is a rare and challenging scenario with few published reports. A 13-year-old boy presented to the emergency department following accidental ingestion of half of a new double-edged shaving razor blade. He was entirely asymptomatic on presentation, with no abdominal pain, hematemesis, melena, or signs of peritoneal irritation. Vital parameters were within normal limits. Serial plain radiographs of the abdomen confirmed progressive distal migration of the metallic fragment. Given concerns about perforation risk from the sharp-edged object, exploratory laparotomy was undertaken after 24 hours of observation. A pre-operative radiograph suggested the blade had reached the distal ileum. Intraoperative examination of the entire small bowel conducted under bright illumination and with the aid of a sterilized magnet failed to locate the fragment. The abdomen was closed after thorough exploration. The postoperative course was uneventful; the patient passed flatus on postoperative day one, and the intact razor blade fragment was identified in the patient's stool on postoperative day two following mild laxative administration. This case illustrates that intraoperative failure to localize an ingested sharp metallic foreign body does not preclude spontaneous passage. It underscores the diagnostic limitations of intraoperative localization techniques and suggests that conservative post-exploration management with laxatives and stool surveillance may be appropriate when no adverse intraoperative findings are encountered. Pre-operative and real-time intraoperative fluoroscopy may enhance localization in future cases.