Ingestion of a fish bone is a cause of small bowel perforation: a case report and review of the literature

ABSTRACT

Sixty two-year old Bahraini man presented with history of lower abdominal pain of four hours duration, not associated with fever, vomiting, constipation or diarrhea. Patients had no urinary symptoms, no history of previous medical problems and no past history of previous abdominal surgery. Blood investigation were within normal ranges. Plain erect abdominal radiography showed dilated small bowel loops, no gas fluid levels and no gas under the right diaphragm. Abdominal computed tomography revealed no free intraperitoneal gas and abnormal small bowel loop with thickened wall and mesentery suggestive of inflammation or ischemia. Patient condition was not improving by conservative measures. Laparotomy was performed and a thickened inflamed ileal loop with a fish bone penetrating through its wall was found. There was minimal peritoneal soiling and omentum was coiled around the perforated ileal loop. The fish bone was removed and the perforation was closed. Patients had uneventful postoperative recovery and was discharged on the 12th postoperative day. Retrospectively he mentioned that he had a fish meal three days prior to the abdominal pain