Diagnostic dilemmas due to fish bone ingestion: Case report & literature review

Abstract

HighlightsPre-operative diagnosis of fish bone perforation of the bowel is difficult.It usually mimics common abdominal pathology.A low threshold must be maintained to perform a diagnostic laparoscopy.

Perforación de íleon distal por espina de pescado: reporte de caso

“…La perforación intestinal es una causa rara de abdomen agudo, con una incidencia de 1 en cada 300 000-350 000 casos. El sitio de perforación ocurre a menudo en un lumen estrecho o en una zona angulada como el íleon distal, válvula ileocecal y el cruce recto-sigmoides (7) .…”

Ingested Fishbone Causing Pericolic Abscess

“…It requires a high degree of suspicion as the patient is unable to provide an appropriate history. In a case report by Hakeem et al, there was a 10-month delay in diagnosis of a fish bone perforation of the small bowel with a localized fluid collection 1,2. Only in 1% cases does the foreign body cause complications such as obstruction and perforation.…”

“…Accidental ingestion of fish bones is not uncommon, and related complications are well documented, especially in the Asian population 1. It requires a high degree of suspicion as the patient is unable to provide an appropriate history.…”

“…Diagnosis on a CECT scan can also prove to be difficult as the calcification of a fish bone can be obscured by contrast 1. An explorative laparotomy provides many advantages in the management of the given case scenario.…”

“…Cases with larger perforations and abscess cavities may require suturing, resection, and exteriorization in the form of colostomy. The other option of minimally invasive laparoscopy should also be considered in cases with no peritoneal contamination 1,4. The decision for laparotomy versus laparoscopic surgery has to be made on a case-by-case basis.…”