Perforation of Ileum by Ingested Chicken Bone Complicating Ventral Hernia

Abstract

THE PURPOSE OF THIS REPORT is to present an unusual case and a discussion of ingested foreign object perforations with special reference to this complication in hernias.CASE REPORT Patient A. L., a 5i-year-old white male of Czechoslovakian birth, entered St. Luke's Hospital at 7:I5 A.M. oni April 5, I945. For the past five years, following an appendectomy through a right rectus incision, he had noted a ventral hernia of increasing size. Seven hours prior to adniission, acute cramp-like pains were noted in and around the hernia with marked tenderness of the hernia. He complained of nausea and belching, but had not vomited. A normal bowel movement three hours prior to admittance was reported to have offered no relief from the pain. The past history, except for appendectomy and subsequent hernia, was negative.Examination revealed an obese white male, anxious and obviously in pain. BP-125/90; Temp.-I00.2 (oral); Pulse-132; Resp.-32. Complete upper and lower artificial dentures were present. Neck, heart and lungs were normal. A grapefruit-sized ventral hernia protruded from the right para-umbilical region. It was tender, hot and irreducible. Bowel sounds were not present within the hernia, and were heard but occasionally in the adjacent abdomen. Laboratory: RBC-4,600,ooo; WBC-Io,650; Hgb.-I4.6 Gm.; urine-chemical and microscopic, negative.A diagnosis of strangulated ventral hernia was made, and immediate operation advised.Operation was carried out under ethylene-nitrous oxide anesthesia supplemelnted with curare intravenously as needed for additional relaxation. The old lower right rectus skin scar was excised. The hernial sac was dissected out and opened. It contained several loops of ileum, three of which were markedly hyperemic and covered with fibrinous exudate. Remaining loops were only slightly cyanotic. Purulent exudate with a foul odor was present in the sac. Two loops of ileum deep in the inferior portion of the sac were found to be adherent to the peritoneum lining the sac. Both fibrous and fibrinous cohesion was encountered. In the course of freeing one of the loops, a chicken bone fragment was discovered protruding through a necrotic patch on the antimesenteric margin of the ileum. The bone was extracted after enlarging the perforation. The serosal fat tags were cleaned from the surrounding ileal surface and purse string closure made. As none of the involved intestine presented permanent circulatory embarrassment,

Perforation by chicken bone in incarcerated intestinal loop of incisional hernia

“…Ya fueron publicadas por Nonat 12 en 1841 y por Ginzburg 20 en 1927. Kilbourne fue uno de los primeros en reportar un caso similar al nuestro en 1948 21 , es decir, de una perforación intestinal por hueso de pollo en asa herniada. Después, Giacom 22 , en 1995, reportó dos casos: uno en una hernia inguinal y otro en una incisional que ambos debutaron con peritonitis aguda.…”

Necrotizing fasciitis resulted from foreign body ingestion and intestinal perforation in an incisional hernia: Report of a case

“…There were very few reports of necrotizing fasciitis that resulted from foreign body stuck in an incisional hernia among literature. [1–4] In the current case, the stuck fishbone perforated the ileum through gastrointestinal tract distortion and narrowed segment of intestine. [1] On the other hand, the reduced distance between the small bowel and abdominal wall facilitates the formation of subcutaneous abscess and NF.…”