A 31-year-old mentally retarded male patient was admitted to the hospital with complaints of a foreign body presenting from the abdomen, abdominal pain, nausea, and fatigue. The patient came standing up and there were no acute abdomen findings. A pointed rusty nail passing through the skin of the abdomen outward from the upper left quadrant was seen.
Abscess material is actively flowing around the nail. In anamnesis, there was a painful swelling on the abdominal wall that lasted for nearly one month. It was perforated in the last few hours and the nail appeared (picture 1).
In the examinations, blood pressure was found to be 105/60 mmHg, fever at 36.6 ºC, WBC at 21.95 10³/mm³, HGB at 11.2 g/dl, PLT at 578 10³/mm\(³\) and CRP at 153.3 mg/L were found.
A nail was seen in the standing direct abdominal X-ray (picture 2). The FAST ultrasound reported 8x4 cm of a loculated fluid collection in the upper left quadrant of the anterior abdomen with a dense septum and air echogenicity, and the intra-abdominal relationship could not be evaluated. On the CT scan, it was reported as a metallic structure extending from the stomach region to the outside of the skin on the left side of the epigastrium (picture 3).
After the necessary preparations were made, the patient was taken to the operation immediately. The abdomen was entered with an upper median umbilical incision. A 25 cm nail perforating the anterior surface of the stomach, peritoneum, skin, and subcutaneous layers was extracted (picture 4).
The inside of the stomach was checked, there were no other foreign bodies. There was an abscess cavity under the skin. The stomach was repaired by wedge resection. The abscess was drained. Subcutaneous and peritoneal necrotic areas were debrided. E. coli was grown in the abscess culture. Appropriate antibiotics were given. The patient was discharged seven days after the operation. No complications developed in routine follow-up.