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Highlights • Operative interventions are still necessary in 1% foreign bodies. • Timely diagnosis can be difficult. Migration to the pancreas, or the anterior abdominal wall, is extremely rare. • Preoperative CT scan locates the foreign bodies and the presence of theirs related complications. • C-arm fluoroscopy is a cost effective intraoperative diagnostic modality which is easily applied., Background Most ingested foreign bodies pass uneventfully through the digestive tract without any major disturbances. Objectives We reports a rare case of successful localization and surgical removal of needles in the gastrointestinal tract using C-arm fluoroscopy intraoperatively. Case report A 46 year old female, a non-hospitalized psychiatric patient, presented with acute abdominal pain. Imaging showed 16 needles all over the digestive tract. C arm fluoroscopy was used to successfully localize and remove all of the needles intraoperatively. One needle was withdrawn from the pancreas manually without pancreatic resection. Discussion It is estimated that up to 10–20% cases require endoscopic removal and 1% cases with the presence of obstruction or perforation necessitate surgical interventions [1], [2], [3], [4] (Hsieh et al., 2005; Anderson and Dean, 2011; Cheng and Tam, 1999; Ricci et al., 2014). Migration to the pancreas extremely rare [5,6] (Toyonaga et al., 2001; Yasuda et al., 2010). Timely diagnosis can be difficult [7] (Tsui and Mossey, 1997). CT scan is a modality of choice to preoperatively locate the foreign body [8] (Takada et al., 2000). We herein successfully localized and removed 15 needles using C-arm fluoroscopy intraoperatively. It is extremely useful to accurately detect radiopaque foreign bodies. On the basic of findings on CT, treatment of choice such as endoscopic removal or surgical intervention may be attempted. Conclusions CT scan is a modality of choice to preoperatively locate the foreign body. Sharp-pointed objects should be removed even if the patient is asymptomatic as the increased mortality and the risk of related complications. Intraoperative C-arm fluoroscopy is a feasible, cost-effective modality with real-time image to accurately detect multiple radiopaque objects especially when they are disseminating throughout the digestive tract.

Highlights • Bezoar-induced small bowel obstruction remains an uncommon diagnosis accounting for 0.4–4% of all mechanical bowel obstruction that poses a diagnostic and management challenge. • It should be suspected in patients with an increased risk of bezoar formation, such as in the presence of previous gastric surgery, poor dentition or a history suggestive of increased fiber intake, or patient with psychiatric disorders. • The presence of well-defined intraluminal mass with mottled gas pattern on CT scan is suggestive of an intestinal bezoar., Introduction Bezoar is an unusual cause of small bowel obstruction accounting for 0.4–4% of all mechanical bowel obstruction. The common site of obstruction is terminal ileum. Case report A 28-year-old male with no past surgical history, known to have severe mental retardation presented with anorexia. CT scan demonstrated dilated small bowel loops and intraluminal ileal mass with mottled appearance. At exploratory laparotomy, a bezoar was found impacted in the terminal ileum 5–6 inches away from the ileocecal valve and was removed through an enterotomy. Discussion Bezoars are concretions of fibers or foreign bodies in the alimentary tract. Small bowel obstruction is one of common clinical symptoms. The typical finding of well-defined intraluminal mass with mottled gas pattern in CT scan is suggestive of an intestinal bezoar. The treatment option of bezoar is surgery including manual fragmentation of bezoar and pushing it toward cecum, enterotomy or segmental bowel resection. Thorough exploration of abdominal cavity should be done to exclude the presence of concomitant bezoars. Recurrence is common unless underlying predisposing condition is corrected. Conclusions Bezoar-induced small bowel obstruction remains an uncommon diagnosis. It should be suspected in patients with an increased risk of bezoar formation, such as in the presence of previous gastric surgery, a history suggestive of increased fiber intake, or patient with psychiatric disorders. CT scan is helpful for preoperative diagnosis.