Retained Hawthorn Fragment in a Child's Foot Complicated by Infection: Diagnosis and Excision Aided by Localization with Ultrasound

Abstract 

Puncture wounds in children are very common and often result in foreign body retention. Organic materials in the form of plant thorns present problems in identification and localization because they are not visualized with plain radiographs. A case of a 10-year-old girl with a small piece of retained hawthorn is presented. Correct diagnosis and treatment were delayed because of misinterpretation of magnetic resonance image studies. Ultrasound ultimately located the foreign body, and assisted in its excision. Plant thorns may be toxic and produce an intense local inflammatory response. In the case described in this article, deep infection caused by Enterobacter cloacae and Pantoea agglomerans was associated with the retained thorn. The small size of the foreign body, misinterpretation of diagnostic images, and the deep infection highlight the challenges that can be encountered by physicians managing puncture wounds in children.

Level of Clinical Evidence: 4

Keywords: diagnostic ultrasound, Enterobacter cloacae, foreign body, Pantoea agglomerans, plant thorn, surgery