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- Adequate volume of barium was administered. The duodenum and proximal jejunum are irregular in contour and margination, with a pleated appearance, most apparent on the initial ‘0’ time images. At ‘0’ time there is a linear filling defect in the most proximal duodenum. Over time there is persistent barium opacification of the duodenum and pylorus and the barium within the duodenum develops a heterogeneous appearance. A short segment of mid jejunum has similar changes. There is a mild delay in gastrocolic transit time. On the ‘0’ time lateral image, there are a number of angular more geometric shaped gas patterns in the jejunum.
- The radiographic changes are most consistent with a linear foreign body within the pyloric outflow tract and duodenum. The heterogeneous/streaking appearance to the barium is commonly seen with absorbing cloth type material. An additional foreign body is likely present in the mid jejunum.
- Images made at 6 hours were available on request. Given that the stomach wasn’t empty at 2 hours and the persistent pyloric and duodenal opacification, continuing the study is a reasonable strategy. Also, cloth type foreign bodies often become more apparent over time as they absorb barium and luminal barium is passed.
- All candidates recognized the pyloric and duodenal changes. However, the changes were often interpretated as infiltrative/inflammatory bowel disease or diffuse adenocarcinoma, with no mention of a foreign body as a differential, and the patient sent for endoscopic biopsies or placed on immunosuppressive therapy. The signalment and history are strong clues in this case and support the radiographic findings.