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Gastrointestinal: Foreign bodies and diverticulitisDiverticulosis is a common disorder in developed countries with a prevalence of approximately 50% in people over the age of 60 years. The disorder is much less frequent in Asia and Africa, perhaps because of a higher intake of dietary fiber. In developed countries, the most common site for diverticula is the sigmoid colon. In contrast, some Asian populations have more frequent diverticula in the right colon. A minority of individuals with diverticulosis have bowel symptoms, but whether these symptoms are due to diverticulosis alone or to a coexisting irritable bowel syndrome remains unclear. Approximately 10% of patients with diverticulosis develop diverticulitis. This is usually caused by a fecolith in a diverticulum that causes chronic inflammation, microperforation and the development of an inflammatory mass (phlegmon). Macroperforations are usually localized as a pericolic abscess but occasionally result in free perforation with peritonitis. A rare cause of diverticulitis is shown in the following case.A 54-year-old woman was referred for evaluation because of pain in the lower abdomen during the preceding 12 months. Prior to presentation, her pain had increased in severity and she had noted some rectal mucus. Mild tenderness was noted on palpation over the left iliac fossa. Colonoscopy revealed a foreign body in the sigmoid colon. Attempts were made to remove the foreign body but it remained firmly lodged, apparently within inflamed diverticula. A computed tomography scan showed extensive sigmoid diverticulosis with a bone impacted in the sigmoid colon (Fig. 1). Laparotomy and sigmoid resection was carried out and revealed a chicken bone, about 3.5 cm in length, that was lodged between two inflamed diverticula and at risk of causing perforation (Fig. 2). Foreign bodies are a rare cause of diverticulitis. It is likely that some of these foreign bodies can be removed at colonoscopy but this was not possible in the case described above.

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