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From question on page 1150

An emergency operation was performed which revealed foreign material which had penetrated into the ileum. A wedge resection of the perforated bowel region was undertaken, and intraperitoneal drainage was performed. The patient was discharged from our hospital nine days postoperatively in good condition.

The object that had been imaged on the computed tomography scan was found to be the foot of a soft shelled turtle (fig 2), commonly referred to as “Supon” in Japanese (scientific name Trionyx sinensis). This turtle is only served on special occasions and is an expensive item for cuisine. Discussions with the patient indicated that he had eaten soft shelled turtle two months before the operation during a new year festival in January. As an aid in identifying this type of situation, it is important to also make use of preoperative computed tomography scans, review the patient’s history in light of any prior operations and, where possible, evaluate the patient’s menu or discuss with the family to recollect any sources of hard body parts that could be an immediate source of the problem.

Figure 2

 A picture of the foot of a soft shelled turtle.

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