Small-bowel perforation caused by fish bone

Abstract

A diagnosis of small-bowel perforation, caused by a sharp or pointed foreign body, is rarely made preoperatively because the clinical symptoms are usually nonspecific and can mimic other surgical conditions, such as appendicitis and diverticulitis. We report the case of a 62-year-old woman who experienced severe pain in the right iliac fossa and fever for about five days before arrival at our hospital. The presumptive diagnosis was acute purulent appendicitis and an emergency appendectomy was planned. Swelling and erythema were noted in a segment of the small bowel in the lower right abdomen. A tiny pointed object was found penetrating the inflamed portion of the bowel, which proved to be a sharp fish bone (gray snapper). The bone was removed, followed by segmental resection of the terminal ileum and ascending colon. The postoperative course was uneventful.

Figure 1

Sonography of the whole abdomen revealed fluid accumulated over the lower right quadrant of the abdomen (arrow).

Figure 2

A: Photograph of the gross specimen shows a sharp fragment of ingested bone penetrating the bowel wall. Inflammatory changes are present; B: The fish bone removed was about 2.5 cm long and had a sharp, pointed tip.