Unforeseen consequences: A case report of misdiagnosis in pediatric ingestion of a fish bone

Abstract

Children are frequently reported as cases of foreign body ingestion, with fishbone ingestion being particularly prevalent in communities where fish consumption is common. Although many instances of foreign body ingestion resolve spontaneously, the ingestion of sharp objects like fishbones poses a greater risk of morbidity and mortality due to their propensity for causing complications. Furthermore, incidents of foreign body ingestion often present with nonspecific symptoms or may go unnoticed, potentially leading to misdiagnosis and complicating the clinical course. We present a case of a 2-year-old boy initially misdiagnosed with constipation and treated with laxatives due to intermittent progressive abdominal pain. Subsequently, he presented to the emergency department where radiological and laboratory investigations revealed signs of inflammation and localized abdominal fluid collection containing a linear hyperdense object, indicating complicated foreign body ingestion with perforation. Urgent laparotomy revealed an omental abscess, which was excised, and the perforation site was repaired with sutures. This case underscores the risk of misdiagnosis and the importance of timely recognition and management. It also emphasizes the critical role of imaging, particularly computed tomography, in accurate diagnosis and differentiation from other common conditions.

Keywords: Abscess; Case report; Fish bone; Foreign body; Pediatric; Perforation; Surgery.

Fig. 1

Supine anteroposterior (A) and lateral (B) X-ray images exhibit unremarkable findings.

Fig. 2

Abdominal ultrasonographic image at the left lower quadrant shows a well-defined fusiform-shaped, heterogeneous, predominantly hypoechoic mass (asterisks) resembling a localized fluid collection, measuring 7.0 × 2.5 cm (length x depth), is observed adjacent to the anterior abdominal wall (black arrowheads) and the colon (white arrowheads). Within this collection, there is a linear echogenic structure (arrow) measuring approximately 2.3 cm in maximum length, suggestive of a suspected foreign body.

Fig. 3

Coronal (A), axial (B), and sagittal (C) abdominal computed tomography images show at the left mid-abdominal region, a linear hyperdense foreign object (arrow), approximately 2.5 cm in length, is visibly lodged within the left intra-abdominal cavity (asterisk), characterized by heterogeneity. This cavity presents as a substantial localized collection, measuring 5.3 × 3.2 × 7.0 cm (craniocaudal × anteroposterior × transverse) in dimensions closely situated adjacent to the anterior abdominal wall (arrowheads).

Fig. 4

Gross intraoperative images. (A) part of the inflamed omentum (black arrow) adherent to the sealed perforation site forming a mass. (B) the resected omental mass with the dislodged foreign body (white arrow) visible. (C) the removed foreign body (i.e. fish bone).