Fishbone Perforated Appendicitis

Abstract

Ingested foreign bodies tend to pass through the gastrointestinal tract without incidence, and vast majority of cases do not need intervention. Rarely, these foreign bodies drop into the appendix and not likely to re-enter the normal digestive tract. We describe a case of a 72-year-old male patient who presented with right iliac fossa pain of 3-day duration. Clinical examination suggested classic acute appendicitis. Blood test results revealed leukocytosis. Computed tomography of the abdomen and pelvis showed evidence of acute appendicitis and a linear hyperdensity (foreign body) perforating the appendix. The patient was managed successfully with prompt laparoscopic appendectomy and removal of the foreign body which was confirmed to be a fish bone measuring about 10mm. While imaging diagnosis of fishbone in the appendix has been published, reports are few. To the best of the author's knowledge, fishbone induced perforated appendicitis has been described only in 2 cases (including this case) in the literature.

Keywords: Fishbone; appendix; computed tomography; foreign body; intestine; perforation.

Figure 1

72-year-old male with fishbone perforated appendicitis. Findings: Contrast-enhanced CT abdomen pelvis in portal venous phase in axial planes show dilated appendix associated with appendiceal wall thickening and enhancement as well as periappendiceal stranding (thick white arrow) in keeping with acute appendicitis. There is 10 mm linear hyperdensity (likely foreign body) at the tip of appendix, which appears to perforate and extend beyond the confines of appendix (thin white arrow). Technique: Contrast-enhanced CT (Philips 256 slice scanner, protocol 120kVp, 3mm slice thickness, 85 ml Omnipaque IV contrast, portal venous phase).

Figure 2

72-year-old male with fishbone perforated appendicitis. Findings: Contrast-enhanced CT abdomen pelvis in portal venous phase in coronal planes show dilated appendix associated with appendiceal wall thickening and enhancement as well as periappendiceal stranding in keeping with acute appendicitis. There is 10 mm linear hyperdensity (likely foreign body) at the tip of appendix, which appears to perforate and extend beyond the confines of appendix (thin white arrow). Technique: Contrast-enhanced CT (Philips 256 slice scanner, protocol 120kVp, 3mm slice thickness, 85 ml Omnipaque IV contrast, portal venous phase).

Figure 3

72-year-old male with fishbone perforated appendicitis. Findings: Contrast-enhanced CT abdomen pelvis in portal venous phase in sagittal planes show dilated appendix associated with appendiceal wall thickening and enhancement as well as periappendiceal stranding in keeping with acute appendicitis. There is 10 mm linear hyperdensity (likely foreign body) at the tip of appendix, which appears to perforate and extend beyond the confines of appendix (thin white arrow). Technique: Contrast-enhanced CT (Philips 256 slice scanner, protocol 120kVp, 3mm slice thickness, 85 ml Omnipaque IV contrast, portal venous phase).

Figure 4

72-year-old male with fishbone perforated appendicitis. Findings: Intra-operative surgical photograph shows an inflamed and dilated appendix with perforation in the mid body (thin blue arrow) secondary to a fish bone which was retrieved as well as an acutely inflamed caecum (thick blue arrow).

Figure 5

72-year-old male with fishbone perforated appendicitis. Findings: Post-operative photograph shows the foreign body (fishbone) retrieved measuring about 10mm.