Large Chicken Bone Impacted in Colonic Diverticulum Mimicking Diverticulitis

Abstract

A 71-year-old woman with a history of diverticulosis presented to the emergency department with left lower quadrant pain for 2 days rated 10 of 10. She had a fever of 38.1°C and a leukocytosis of 12.8 k/mm 3 . A computed tomography scan revealed sigmoid diverticula, focal wall thickening, fat stranding, and a linear hyperdensity in the sigmoid colon (Figure 1). She was started on antibiotics and admitted for the management of diverticulitis and pain. Concern for a possible foreign body evidenced by the linear hyperdensity drove the decision to proceed with colonoscopy. On colonoscopy, a chicken bone was found impacted in a sigmoid colon diverticulum with surrounding inflammation (Figures 2 and 3). It was successfully removed with a rat tooth forceps without complications or subsequent signs of mucosal perforation (Figure 4). Her symptoms improved, and she was discharged with oral antibiotics. She did not recall ingesting the bone.Acute diverticulitis is normally a contraindication to colonoscopy because of risk of perforation. 1 However, in this instance when the precipitant of inflammation is a foreign body, a colonoscopy can be cautiously attempted for removal.