Fishbone perforation of the small bowel mimicking internal herniation and obstruction in a patient with previous gastric bypass surgery

Abstract

Intestinal perforation following the ingestion of fishbone is unusual and rarely diagnosed preoperatively, as clinical and radiological findings are non-specific. We report a case of a female patient post Roux-en-Y gastric bypass (RYGBP) for obesity, who presented with severe abdominal pain and guarding in left iliac fossa. Computed tomography (CT) suggested internal herniation with compromised vascular supply to the bowel. Exploratory laparotomy identified a perforation site in the blind loop of the RYGBP due to a protruding fishbone. After extraction, primary suture repair was performed. In retrospect, the fishbone was identified on CT but misinterpreted as suture line at the enteroenterostomy site. This case emphasizes that although rare, the ingestion of fishbone can lead to severe complications and should therefore be included in the differential for an acute abdomen. On CT, it should be noted that fishbone may simulate suture line within the bowel if the patient has history of previous surgery.

Submucosal protuberance caused by a fish bone in the absence of preoperative positive signs: A case report

“…There may be several reasons why the patient in our case did not show any obvious signs of fish bone ingestion upon ancillary examination. First, ingested fish bones are usually very small, and the superficial changes can easily be mistaken as calcifications and surgical suture[ 13 ], or ignored altogether due to the influence of gastric content. Second, if the fish bone was from a cartilaginous species of fish, it would have low density on CT and be hypoechogenic on EUS, thus making it difficult to differentiate it from surrounding soft tissue and hard to identify using CT imaging modalities.…”

Thủng đại tràng ngang do vô tình nuốt tăm tre: Báo cáo một trường hợp

“…Nuốt phải dị vật là một tình huống khá thường gặp trong cuộc sống [1], [2], [3], [4], [5], [6]. Khoảng 90% các dị vật nuốt vào không có triệu chứng và được thải ra ngoài theo đường tiêu hóa mà không gây ra bất kỳ biến chứng nào.…”

Small intestinal press‐through package perforation

“…Approximately 75% of swallowed foreign bodies are reportedly spontaneously expelled, and approximately 1% cause intestinal perforation 1 . Perforation owing to foreign bodies is commonly observed in areas where the intestinal anatomy is narrow or at an angle, such as at the cricopharyngeus, lower esophagus, or the ileocaecal and rectosigmoid junctions 1,2 …”

“…Approximately 75% of swallowed foreign bodies are reportedly spontaneously expelled, and approximately 1% cause intestinal perforation. 1 Perforation owing to foreign bodies is commonly observed in areas where the intestinal anatomy is narrow or at an angle, such as at the cricopharyngeus, lower esophagus, or the ileocaecal and rectosigmoid junctions. 1,2 Currently, in Japan, the perforation line for PTPs is made in only one direction, such that they cannot be divided into small pieces to prevent accidental PTP ingestion.…”

“…1 Perforation owing to foreign bodies is commonly observed in areas where the intestinal anatomy is narrow or at an angle, such as at the cricopharyngeus, lower esophagus, or the ileocaecal and rectosigmoid junctions. 1,2 Currently, in Japan, the perforation line for PTPs is made in only one direction, such that they cannot be divided into small pieces to prevent accidental PTP ingestion. However, older adults sometimes divide PTPs into single-dose pieces using scissors to easily identify the right amount of medicine.…”