Small bowel perforation caused by a fish bone in a patient with vascular Ehlers-Danlos syndrome: a case report

Abstract

Management of gastrointestinal perforation in patients with vascular Ehlers-Danlos syndrome (vEDS) is clinically challenging. A male in his 40s with vEDS presented with right lower abdominal pain. Computed tomography revealed a foreign body in the ileum with bowel perforation. A detailed inquiry revealed that he had consumed codfish six days prior. Based on these findings, he was diagnosed with a small bowel perforation caused by a fish bone. Emergency laparotomy was performed and intraoperative findings showed a fish bone in the ileum penetrating the mesentery. We resected ~5 cm of the small intestine, including the perforation site. Although the patient experienced postoperative paralytic ileus, he was discharged on postoperative Day 27. Gastrointestinal perforation caused by fish bones in patients with vEDS is extremely rare and requires careful assessment to determine the appropriate treatment. For surgeons, an individualized surgical strategy and optimal perioperative management are important to prevent fatal complications.

Keywords: fish bone; intestinal perforation; vascular Ehlers-Danlos syndrome.

Figure 1

Contrast-enhanced computed tomography before surgery. A sharp foreign body with bowel perforation was identified in the ileum. Free air was localized in the mesentery and no abscess formation was observed.

Figure 2

Intraoperative findings. Severe adhesions of the small intestine were observed and a sharp 4 cm foreign body was located 15 cm proximal to the terminal ileum penetrating the mesentery through the ileal wall (arrow).

Figure 3

Macroscopical findings. Approximately 5 cm of the small intestine, including the perforation site, was resected. The foreign body was confirmed to be a fish bone.