[Skip to Content]
[Skip to Content Landing]

Acute Abdominal Pain in a Postmenopausal Woman

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
1 Credit CME

A postmenopausal woman in her mid-50s (gravida 2, aborta 2) with a known history of endometriosis and adenomyosis presented to the emergency department with severe abdominal pain that she rated 10 of 10 in intensity and which had developed suddenly 5 days before presentation. The abdominal pain was associated with diarrhea, nausea, and abdominal bloating. On examination, the patient was afebrile and her abdomen was soft and nondistended without guarding or rebound but tender in the left lower quadrant. The patient had a palpable nodule in the posterior vaginal fornix and fullness in the left lower quadrant of the abdomen on bimanual examination.

Please finish quiz first before checking answer.

You answered correctly!

Read the answer below and download your certificate.

You answered incorrectly.

Read the discussion below and retake the quiz.

C. Perforation by foreign bodies

In the Figure, arrowheads indicate the presence of metal brush filaments in the omentum caudal to the transverse colon and in the cul-de-sac adjacent to the upper rectum. There is the potential that metal bristles of barbeque brushes may be dislodged, adhere to food on the grill, and be ingested. If ingested, the metal bristles may cause injury to and/or perforate the gastrointestinal tract, which can lead to severe complications.15 Health Canada, the Centers for Disease Control and Prevention, and the media have made an effort to report cases of injury and inform the public of this problem.3,6,7 However, it is also important that physicians are aware of the clinical presentation, radiologic findings, and management options associated with injuries related to ingested metal barbeque brush bristles to ensure that patients with such injuries receive efficient diagnosis and treatment, especially in the summer months during barbeque season.

Survey Complete!

Sign in to take quiz and track your certificates

Buy This Activity
Article Information

Corresponding Author: Sukhbir S. Singh, MD, FRCSC, Department of Obstetrics and Gynecology, The Ottawa Hospital, University of Ottawa, 1967 Riverside Dr, 7th Floor, Ottawa, ON K1H 7W9, Canada (susingh@toh.on.ca).

Published Online: July 11, 2018. doi:10.1001/jamasurg.2018.2016

Conflict of Interest Disclosures: Dr Singh reports having participated in a speakers bureau and receiving research grants and consulting fees from Bayer Pharma, Allergan, and AbbVie and having received consulting fees from Cooper Surgical. No other disclosures are reported.

Additional Contributions: We thank the patient for granting permission to publish this information. Carolyn Nessim, MD, FRCSC (Division of General Surgery, Department of Surgery, The Ottawa Hospital, University of Ottawa), was involved in the patient’s care, provided content expertise, and assisted with preparation of the manuscript; she received no compensation for her contribution.

References
1.
Sordo  S, Holloway  TL, Woodard  RL,  et al.  Small bowel perforations by metallic grill brush bristles: clinical presentations and opportunity for prevention.  Am Surg. 2016;82(5):412-415.PubMedGoogle Scholar
2.
Baugh  TP, Hadley  JB, Chang  CW.  Epidemiology of wire-bristle grill brush injury in the United States, 2002-2014.  Otolaryngol Head Neck Surg. 2016;154(4):645-649. doi:10.1177/0194599815627794PubMedGoogle ScholarCrossref
3.
Grand  DJ, Egglin  TK, Mayo-Smith  WW, Cronan  JJ, Gilchrist  J.  Injuries from ingesting wire bristles dislodged from grill-cleaning brushes: Providence, Rhode Island, 2009-2012.  J Safety Res. 2012;43(5-6):413-415. doi:10.1016/j.jsr.2012.10.008PubMedGoogle ScholarCrossref
4.
Grand  DJ, Cloutier  DR, Beland  MD, Mayo-Smith  WW.  Inadvertent ingestion of wire bristles from a grill cleaning brush: radiologic detection of unsuspected foreign bodies.  AJR Am J Roentgenol. 2012;198(4):836-839. doi:10.2214/AJR.11.6991PubMedGoogle ScholarCrossref
5.
Wong  S, Brook  C, Grillone  G.  Management of wire brush bristle ingestion: review of literature and presentation of an algorithm.  Ann Otol Rhinol Laryngol. 2016;125(2):160-164. doi:10.1177/0003489415599992PubMedGoogle ScholarCrossref
6.
Government of Canada. Barbeque safety. https://www.canada.ca/en/health-canada/services/home-garden-safety/barbecue-safety.html. Accessed October 12, 2017.
7.
Kubinec  VL, Nicholson  K. Wire-bristle BBQ brush incident reports more than double. http://www.cbc.ca/news/canada/manitoba/i-team-bbq-bristle-reports-1.4354745. Accessed October 20, 2017.
8.
Zhuo  J, Gullapalli  RP.  AAPM/RSNA physics tutorial for residents: MR artifacts, safety, and quality control.  Radiographics. 2006;26(1):275-297. doi:10.1148/rg.261055134PubMedGoogle ScholarCrossref
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_LoginSubscribe_Purchase
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_LoginSubscribe_Purchase
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right

Name Your Search

Save Search
With a personal account, you can:
  • Track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
jn-learning_Modal_SaveSearch_NoAccess_Purchase

Lookup An Activity

or

My Saved Searches

You currently have no searches saved.

With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Topics
State Requirements