An Interesting Case of Duodenal Perforation With Penetrating Hepatic Injury by an Ingested 17 cm Long Neem Stick

Foreign bodies, ingested either accidentally or intentionally usually pass through gastrointestinal tract uneventfully. However few cases presents with complications such as perforation, obstruction or haemorrhage or fistula formation. Perforation is mainly caused by long pointed objects. Here, we report the case of a 45 year old female who presented to us with sudden onset severe pain all over abdomen. Chest radiograph showed gas under right diaphragm. Laparotomy revealed a 17 cm long Neem (Azadirachta indica) stick, which was found perforating through the first part of duodenum and penetrating into the inferior surface of left lobe of liver. We believe this to be the first reported case of bowel perforation with penetrating hepatic injury caused by an ingested neem stick/ datun.