PMC7481749_01
Multiple foreign bodies with "spoke wheel appearance" in small bowel. Contrast-enhanced CT scan image of abdomen (A) axial and (B) coronal reformatted images demonstrate multiple round-oval foreign bodies (arrow) in small bowel with circumferential wall edema (arrow head) of the small bowel. (C) Axial CT image of seed of Lapsi demonstrating hyperdense periphery; spoke wheel like appearances and air attenuating areas within.
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A contrast enhanced computed tomography (CECT) of abdomen and pelvis showed: (1) Dilated segment of jejunum with circumferential submucosal edema and abrupt distal narrowed lumen suggestive of stricture. (2) Multiple round (in axial plane) to oval (longitudinal plane) hyperdense foreign bodies of nearly similar size with air attenuating areas and spoke wheel appearance was noted in the dilated bowel (Fig. 1A & B). The CT image of lapsi seed stone in vitro showed the identical features as shown in vivo (Fig. 1C).
Diseased part of intestine. (A) Dilated and inflamed terminal jejunum due to prolonged reaction of foreign body resided within the lumen; Stricture sites noted in the distal inflamed jejunum (B) Anti-mesenteric side and (C) Mesenteric side; (D) Removed 19 Lapsi seed stones.
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The intraoperative findings were: dilated and inflamed distal jejunum (~40 cm length) located ~200 cm distal to ligament of treitz (Fig. 2A); two stricture sites at 7 cm apart were noted distal to inflamed jejunum (Fig. 2B & C); and, there was no evidence of bowel ischemia. Nineteen lapsi seed stones (each measuring ~2.5cm x 1.8cm x 1.8 cm) were removed (Fig. 2D).
PMC7481749_02