Be careful what you wish for: an ingested foreign body masquerading as cancer

Abstract

We present a case in which a patient with suspected colorectal cancer, referred to the surgical outpatient clinic, was subsequently found to have a chicken wishbone apparently perforating the sigmoid colon. This demonstrates the complexities of diagnosis and management of an unusual presentation of ingested foreign body. This case is a useful learning point in consideration of differential diagnosis in the presentation of an apparently malignant lesion.

Gastric perforation by a foreign body presenting as a pancreatic pseudotumour

“…Ingested pieces of crab shell and chicken bone caused localised reactions mimicking tumours of the omentum and stomach, respectively 11,12 . In another, an oesophageal granuloma was diagnosed secondary to trauma from an ingested fish bone 13 and colonic pseudo-tumour formation resulted from an ingested chicken bone 14 . As suggested previously, these examples of more insidious clinical presentations occurred following perforation of more muscular viscera.…”

“…One other case report has been found in which a localised pancreatic inflammatory reaction mimicking a tumour of the pancreatic head was caused by a perforation 14 . However, in this example a Whipple's procedure was performed for suspected pancreatic malignancy, highlighting the necessity of recognising this rare presentation 15 …”

Case report of abdominal left upper quadrant collection secondary to fish bone perforation

“…We could not perform the coloscopy to eliminate a colonic malignant process as a standard procedure in other case reports [6,20]. The patient had no personal or family risk factors for colorectal cancer and the progressive sepsis raised the suspicion of possible colon perforation with peritonitis that contraindicated the preparation and the colonoscopy.…”

“…The delay in passing the cardia and the duodenum makes correlation with later symptoms difficult, because patients usually do not remember the time of ingestion. In contrast to a gastro-duodenal perforation by a foreign body complicated with chemical peritonitis that is quite symptomatic, a colon perforation may evolve with a sub-acute clinical peritonitis and/or abscess formation; this may mean milder symptoms; adding a significant delay from the intake of the foreign body, the presentation leaves the differential diagnosis open for debate at admission time between emergency room (ER), radiology and surgeons [ 1 , 3 – 6 ]. A case series report about ingested radio-opaque foreign bodies describes a mean time for spontaneous passage through the digestive tract of less than 1 week in 75% of cases, with a mean hospital stay of 3.4 days.…”

“…Most foreign bodies may pass spontaneously through the digestive tract; some of them may need endoscopic extraction while surgery is seldom needed [ 1 , 2 ]. Fish bones are the most frequently ingested organic foreign objects, but complications such as mechanical obstruction or small bowel perforation are rare [ 2 – 6 ].…”