A 28-year-old man was transferred to our hos pital due to abdominal pain within the past 72 hours that started in the epigastric region and then became localized in the right iliac fossa.

He had a history of right inguinal hernia repair with mesh, a previous hospitalization for a stab wound in the thorax without surgical repair and reported vo luntary ingestion of an air rifle pellet 20 days before.

The abdomen was soft and depressible on palpation, with tenderness, guarding and rebound ten derness on McBurney’s point. Acute appendicitis was suspected and the patient underwent preoperative assessment, including an abdominal X-ray taken in the standing position which demonstrated the presence of a pellet in the area of the appendix (Fig. 1).

Figure 1 Plain abdominal X-ray showing a foreign body in the right iliac region suggestive of the ingested air rifle pellet. 

Open surgery was decided. The abdomen was approached via a McBurney incision. Upon entering the cavity, a mass of adhesions was observed in the cecal region and was released with the fingers. A perforated gangrenous vermiform appendix with a foreign body (FB) was found free in the cavity (Fig. 2). The FB was removed, and after ligation of the mesoappendix, the base (free of injury) was ligated twice and the appendix was removed.

Figure 2 Gangrenous appendicitis with an air rifle pellet as possible cause of endoluminal obstruction 

The patient evolved with favorable outcome and was discharged on postoperative day two.

Ingestion of FBs is not uncommon, especially among the pediatric age group, patients with mental disorders, or inmates^1-5.

Most ingested FBs pass through the gastroin testinal tract without causing major symptoms or requi ring surgical treatment, although long, sharp, pointed and metallic objects usually cause symptoms. Up to 75% of the cases have a history of ingestion of this type of objects on presentation^1,2,5. Some blunt FBs may lod ge in the appendix without causing any symptoms for years, as E. R. Reddy reported in a study performed in Eskimos⁶.

Acute appendicitis usually originates from an endoluminal obstruction, in most cases due to a fe calith. Other less common causes are endoluminal obstruction due to lymphoid hyperplasia, parasites, in flammation and neoplasms. Appendicitis due to foreign body is extremely rare (1:2000 appendectomies)³.

Despite its low prevalence, several objects have been found in the appendiceal lumen (coins, nee dles, nails, dental material, pellets, etc.)².

The diagnosis is made in a patient with a history of ingestion of FB, abdominal pain and fin dings in imaging tests⁴. In the absence of ingestion, and in radiolucent FBs, the diagnosis is frequently incidental.

Several authors recommend video-assisted co lonoscopy to remove FBs within the appendix^2-4. If the procedure fails, surgery is indicated.

In our case, we did not perform an endoscopic procedure or laparoscopic surgery due to limitations of the equipment and availability in our hospital.

To date, there are some reports in the English literature of appendicitis caused by the accidental in gestion of pellets in people who eat game meat (as ha res or rabbits)^3,4. We believe that this is the first case published in Argentina of appendicitis due to ingestion of air rifle pellet.