Extra luminal migration of ingested fish bone to the spleen as an unusual cause of splenic rupture: Case report and literature review

Abstract

Introduction: The ingestion of foreign bodies (FB) is a common problem worldwide and affects all ages; it is, however, particularly important in the pediatric population and in mentally impaired adults. The typical outcome of FB ingestion is good, since the majority of ingested material is passed spontaneously through the gastrointestinal tract. Serious complications can occur, however, including bowel perforation or obstruction and gastrointestinal bleeding, amongst others. Extraluminal migration of ingested foreign bodies is very rare and reported cases so far have shown, more commonly, migration to neck structures, with very few reported cases of migration to the abdomen. To date, there is no reported case of extraluminal migration of ingested FB to the spleen.

Case presentation: A 59-year-old man presented with acute abdominal pain and dyspnea. A CT scan revealed a FB within the spleen, with a ruptured capsule and perisplenic collection. Surgery was performed and a 3cm-long fishbone was extracted, with hemoperitoneum secondary to spleen rupture. The patient was discharged on the third postoperative day with good recovery and without any complications; pneumococcal polysaccharide vaccination was provided.

Conclusion: FB ingestion is a relatively benign condition; however, some serious complications can arise infrequently. The patient reported herein is the first in the literature to present a splenic rupture due to extra luminal migration of an ingested fish bone.

Keywords: Acute abdomen; Colon perforation; Fish bone; Foreign bodies; Foreign-body migration; Splenic rupture.

Fig. 1

Abdominal CT scan. (A) Coronal plane (B) Sagital Plane. Shows splenic rupture associated with a subcapsular hematoma and the presence of a linear hyperdense foreign body in the spleen, of 3.0 cm, close to the splenic flexure of the colon.

Fig. 2

Laparotomy and splenectomy images. (A) Surgical field during splenectomy and surgical drainage of hemoperitoneum that shows the presence of a large fishbone (Black arrow); (B) Fishbone recovered during surgery.

Fig. 3

Gross examination of specimens obtained during surgery. (A) An Enlarged spleen (13.5 × 10 × 5 cm) that weighted 342.1 g, with a subcapsular hematoma of 9 × 7 cm and a traumatic rupture of 80% of the posterior aspect; (B) Sharp large fishbone of 3 × 0.1 × 0.1 cm.