Rare case of omentum-wrapped abscess caused by a fish bone penetrating the terminal ileum

Abstract

Accidentally ingested foreign bodies, for the most part, pass through the gastrointestinal tract, but can cause several complications. Perforation is rare, but can occur in any segment of the gastrointestinal tract. Intestinal perforations due to foreign bodies are rarely diagnosed preoperatively as clinical symptoms are non-specific and they can mimic other abdominal conditions. We describe a case of a 48-year-old patient who was admitted to the emergency room because of severe abdominal pain of 5 d duration. A computed tomography scan showed an undefined liquid collection involving a linear image 35 mm in size, suggestive of a foreign body. On laparotomy, an abscess containing a fish bone was resected. As fish bone ingestion is usually not remembered by the patient, the diagnosis can be delayed. The preoperative diagnosis is frequently acute abdomen of unknown cause. A low threshold of suspicion along with a good clinical history and radiological studies are extremely important in order to make a correct diagnosis.

Keywords: Fish bone; Foreign body; Terminal ileum perforation.

Figure 1

Computed tomography, resected abscess and fish bone and the lacation of perforation in terminal ileum. A: Axial and sagittal slides of abdominal computed tomography scan. It is visible an undefined liquid collection involving a linear image suggestive of foreign body (arrow); B: The resected abscess size and fishbone (arrow); C: The perforation in terminal ileum (arrow).