A Case Report on Fish Bone Perforating Meckel’s Diverticulum Mimicking Appendicitis

Abstract

Meckel's diverticulum (MD) is the most frequent congenital abnormality of the digestive tract. Although it is silent, it can rarely come up as a complicated case including but not limited to obstruction, inflammation, and neoplasm. Perforation as a consequence of MD is extremely infrequent and mostly related to foreign objects. We report a case of a 24-year-old man who presented to the emergency department with signs and symptoms suggestive of acute appendicitis. Computed tomography (CT) of the abdomen demonstrated foreign body perforation from a protrusion outside the small bowel. The patient underwent laparoscopy and a fish bone perforating MD was found which was removed.

A rare cause of acute abdomen after a Good Friday

“…In a similar context, other radiological features of fish bone perforation were described in a case report published in 2022, such as thickening of the intestinal wall, fatty deposits, intestinal ileus, ascites, localized pneumoperitoneum, intra-abdominal abscess, and a linear hyperdense structure in the abdominal cavity within the gastrointestinal tract or a parenchymal organ, often surrounded by inflammation[ 4 ]. Therefore, the combination of a detailed medical history with imaging and ancillary testing (ultrasound and abdominal CT) is crucial in cases of acute abdomen that may require surgery[ 5 , 6 , 7 ].…”

“…There is a wide range of complications associated with this disease, such as acute or chronic abdominal pain, anemia, gastrointestinal bleeding, obstruction, and perforation[ 1 , 3 ]. Although most of these complications are not rare, small bowel perforation caused by an ingested fish bone is a rare finding, occurring in less than 1% of patients[ 2 ], because, in most cases of ingested foreign bodies, the object will pass through the gastrointestinal tract without any complications[ 4 ].…”

“…In addition, patients do not always recall ingesting the foreign body, and fish bones are not easily detected on radiographs or CT scans[ 2 , 3 ]. The perforated Meckel’s diverticulum may also mimic acute appendicitis, acute diverticulitis, and colitis[ 4 ]. In the case presented here, the patient complained of severe abdominal pain in the right lower quadrant, similar to that of acute appendicitis.…”

“…Imaging is essential to determine the correct diagnosis prior to surgery. Radiography is not a reliable means to detect a fish bone, because it lacks sensitivity for the aerodigestive tract[ 4 ]. Although abdominal ultrasound is useful in identifying a foreign body based on high reflectivity and variable posterior shadowing, CT is the imaging modality of choice for the detection of foreign bodies and other acute abdomen conditions[ 4 ].…”

Abdominal pain from ingested bone misdiagnosed as appendicitis: Report of a rare case and literature review

“…Impaction places include distal duodenum, jejunum, terminal ileum, ileocecal junction, distal sigmoid colon, and Meckel's diverticulum. Additionally, all cases reported negative CT and Ultrasound scans, and the patients were only diagnosed with an ingested foreign bone then suggest laparoscopy and laparotomy [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] . Therefore, clinicians should not count very much on the imaging results to exclude the ingestion of foreign bodies despite its rarity.…”