{
  "abstract": "A 54-year-old woman presented with recurrent abdominal distension for 1 month and right upper quadrant pain for 2 days. For her 5-year history of type 2 diabetes mellitus, she self-treated exclusively with daily Wu Jia Pi herbal wine. She denied alcohol consumption. She took no prescription medication and was a lifelong non-smoker. Physical examination revealed mild tenderness in the right upper quadrant without signs of peritoneal irritation. Laboratory tests showed neutrophilia (11 250/µL), normal haemoglobin (11.2 g/dL) and mildly elevated inflammatory markers (C-reactive protein, 8.57 mg/L; procalcitonin, 0.45 ng/mL). Infectious disease screening (HIV, Epstein–Barr virus) and autoimmune tests were negative. Although both tuberculosis screening tests were positive (the T-SPOT.TB assay and the purified protein derivative skin test), chest CT was unremarkable. This effectively excluded active tuberculosis. Abdominal CT demonstrated marked dilation of the ascending colon with thickened bowel wall and intramural high-density signals at the hepatic flexure (figure 1A), accompanied by linear calcifications along mesenteric veins (figure 1B). Colonoscopy was advanced to the proximal ascending colon but not completed to the caecum due to stricture and revealed markedly oedematous and bluish-purple mucosa (figure 2A), with a sharp triangular foreign body impacted at a site of luminal narrowing (figure 2B) which was successfully retrieved via endoscopy (figure 2C,D). On reinterview, the patient recalled accidentally swallowing a bony object 1 week earlier. Histopathological analysis of mucosal biopsies revealed non-specific inflammation without caseating granulomas. The patient was advised to discontinue herbal wine intake to eliminate the presumed toxin exposure; intravenous cefotaxime, oral mesalazine and probiotics were prescribed. However, symptoms recurred and progressively worsened over the following year, characterised by persistent abdominal pain and distension. Repeat CT confirmed ongoing colonic dilation and persistent stenosis suggestive of partial intestinal obstruction. Ultimately, surgical exploration revealed focal sclerosis and significant rigidity of the ascending colon. A right hemicolectomy with ileocolic anastomosis was performed.",
  "authors": [
    {
      "affiliations": [
        "Department of Gastrointestinal Endoscopy, Fujian Provincial Hospital, Fuzhou, Fujian, China",
        "Provincial Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China"
      ],
      "name": "Jiaqing Hu"
    },
    {
      "affiliations": [
        "Department of Gastrointestinal Endoscopy, Fujian Provincial Hospital, Fuzhou, Fujian, China"
      ],
      "name": "Xiaoling Zheng"
    },
    {
      "affiliations": [
        "Provincial Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China",
        "Department of Gastrointestinal Surgery, Fujian Provincial Hospital, Fuzhou, China"
      ],
      "name": "Changshun Yang"
    }
  ],
  "title": "Hidden culprit: an unexpected diagnosis beneath a colonic foreign body",
  "uid": "cc54ce91-f13b-5d41-b364-1448f3c2fd65"
}