Ingested metallic screw causing appendicitis in an infant--the metallic 'Screw Appendicitis'.

An eleven month male baby presented with 2 day history of irritability, refusal to feed, fever and diarrhea with tenderness and guarding in the right iliac fossa (RIF). Abdominal X-ray (AXR) showed a metallic screw in the RIF (Fig.1). On probing, parents revealed, baby was fed a metallic screw by an older child 4 mo ago. Since then serial AXRs done by a ‘medical quack’ showed mild changes in the position of the screw restricted to RIF. Ultrasonography showed no intussusception and appendix was not visualized. Diagnosis of FB appendicitis was made, but possibility of FB impacted in cecal wall, ileocecal junction, meckel’s diverticulum and rare appendicular or ileocecal tuberculosis was also considered. At surgery, inflamed appendix filled with pus and an impacted metallic ‘screw’ was found. Screw retrieved by appendectomy measured 1.5 cm x 0.3 cm. Appendectomy was done and histopathology confirmed acute appendicitis without any evidence of tuberculosis.