A fish bone causing ileal perforation in the terminal ileum

Abstract

Gastrointestinal sistemin yabancı cisimlerle perforasyonu farklı klinik tablolarla kendini gösterebilir ve operasyon öncesi doğru tanı nadiren konulur. Biz hastanemize sağ alt karın ağrısı ile başvuran, klinik olarak akut apandisit ve divertikülit öntanıları düşünülen, 69 yaşındaki kadın hastanın multidedektör bilgisayarlı tomografi incelemesinde balık kılçığına bağlı terminal ileum perforasyonu saptadık. Bu gibi olgularda doğru tanı koyabilmek için öncelikle klinik olarak şüphelenmek gerekir.Anahtar Sözcükler: Bağırsak perforasyonu; balık kılçığı; multidedektör bilgisayarlı tomografi.Foreign body perforation of the gastrointestinal (GI) tract has diverse clinical manifestations, and the correct preoperative diagnosis is seldom made. We report the case of a 69-year-old woman who experienced severe pain in the right iliac fossa. The presumptive diagnosis was acute purulent appendicitis or diverticulitis. Multidetector computed tomography (MDCT) imaging showed the fish bone perforation of the terminal ileum. A high index of suspicion should always be maintained in order for the correct diagnosis to be made.Key Words: Bowel perforation; fishbone; multidetector computed tomography.Foreign body (FB) ingestion is a common clinical problem seen in emergency departments. Most ingested FBs pass through the gastrointestinal (GI) tract uneventfully within one week, [1] and GI perforation is rare, occurring in less than 1% of patients. [2,3] Fish bones are the most commonly ingested objects and the most common cause of FB perforation of the GI tract. FB perforation of the GI tract has diverse clinical manifestations, and the correct preoperative diagnosis is seldom made.We report the case of fish bone perforation of the distal ileum, resulting in a clinical presentation mimicking acute appendicitis. CASE REPORTA 69-year-old woman, with no previous abdominal complaints, was admitted to our emergency department with acute abdominal pain in the lower right quadrant for the preceding two days. There was no nausea, vomiting or diarrhea. Physical examination revealed a body temperature of 38.2°C. An abdominal examination showed localized tenderness in the lower right quadrant with rebound and voluntary guarding. Laboratory tests indicated an elevated white cell count of 12,400 with 88% neutrophils. A plain X-ray of the abdomen showed local ileus in the lower right quadrant. Sonography of the whole abdomen revealed minimal fluid collection in the pelvic region. The appendix could not be visualized due to the overlying small intestinal loops. The presumptive diagnosis was acute purulent appendicitis and an emergency appendectomy was planned. Before the emergency operation, abdominal multidetector computed tomography (MDCT) imaging was planned for the patient. MDCT showed a localized pneumoperitoneum surrounded by inflammatory mesenteric fat that was found in the vicinity of a short focally thickened ileal segment impacted by the fish bone (Figs. 1, 2). The appendix appeared normal and there was a minimal pelvic fluid collection. Th...

Intestinal perforation due to fish bone diagnosed preoperatively by computed tomography

“…Meat boluses are the most common foreign bodies ingested in Western countries, while fish bones are the most common in Oriental countries where unfilleted fish is a culinary delicacy [1,2]. Although most fish bones pass through the gastrointestinal tract without complications, patients who accidentally ingest a fish bone are occasionally asymptomatic after ingestion initially, but may at a later date present remotely with serious complications such as perforation, obstruction, and abscess formation in the gastrointestinal tract.…”

Laparoscopic Resection and Intracorporeal Anastomosis of a Perforated Small Bowel Caused By Fish Bone Ingestion

“…The most common causes of intestinal perforation depending on FB are fish bones, chicken bones and sharp objects such as toothpicks in adults. [1,3] However perforation by FB ingestion is a rare clinical condition. Perforation most often occurs at the ileocecal and rectosigmoid level following the stomach and duodenum at areas of angulation.…”

“…Perforation of the small bowel by FB is rare clinical finding, occurring in less than 1% of patients. [1] Fish bones are the most commonly ingested organic objects and most common cause of FB perforation of the gastrointestinal tract. [1,2] Preoperative diagnosis is usually challenging, since ingestion is mostly accidental.…”

Balık kılçığına bağlı intestinal perforasyon

“…MDCT, in which only water is used to distend the GI tract and thinner CT slices can overcome these problems 2 . Furthermore, MDCT allows multiplanar reconstructions which would be useful in orientation and trace structures such as blood vessels to differentiate from an extraluminal foreign body 13 . In our case 16-MDCT with neutral contrast medium and 2 mm slice thickness was used and coronal reconstruction of the images facilitated the diagnosis.…”