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

Multiple abdominopelvic abscesses caused by fishbone: A case report of rare etiology and literature review

INTRODUCTION AND IMPORTANCE

Foreign body ingestion, particularly fishbone, is a prevalent medical complaint in the emergency department. Usually, these foreign substances pass through the gastrointestinal tract without causing any complications. The clinical manifestations of foreign body consumption are non-specific.

CASE PRESENTATION

A 32-year-old male patient presented to our hospital with severe abdominal pain. Physical examination revealed a distended abdomen and tenderness. Plain chest and abdominal X-rays were unremarkable. The performed computed tomography (CT) of the abdominopelvic region showed multiple abscesses. Then, an exploratory laparotomy was decided during which a foreign body, a fishbone, was detected and the affected omental mass was resected, and abscess drainage was done. The resected specimen was sent for histopathological studies. The postoperative period was uneventful.

CLINICAL DISCUSSION

Perforation of the intestinal wall by fishbone ingestion is an unusual entity. The clinical features of intestinal perforation are usually non-specific resulting in delayed diagnosis. Based on individual situations, the treatment strategy can be surgical or non-surgical.

CONCLUSION

Even though ingesting a foreign body is a frequent complaint in clinical practice, its repercussions are extremely rare. Our case presented multiple intra-abdominal abscesses and perforation as a complication of accidental fishbone ingestion.

Migration of an ingested fishbone to the uterine wall: A case report

This paper reports the first case of the removal of an ingested fishbone from the uterus. A 77-year-old woman presented with a 3-day history of lower abdominal pain. An abscess-like lesion in the posterior wall of the uterus was revealed by transvaginal ultrasonography and pelvic magnetic resonance imaging. Moreover, a curvilinear calcium density in the anterior uterine wall was revealed by abdominal computed tomography. A recto-sigmoidal perforation and uterine abscess were suspected. Thus, hysteroscopic drainage of the abscess was performed. Hysteroscopy revealed a fishbone partially embedded in the myometrium. Its removal resulted in full recovery. This study believed that adhesions between the uterus and rectosigmoid colon after partial gastrectomy for gastric cancer may have limited abdominal symptoms by limiting the leakage of intestinal fluids. Although rare, it should be considered that migration of a fishbone into the uterus could occur.

Fish bone perforation mimicking colon cancer: A case report

Most patients who ingest fish bones do not develop any complications. The small proportion of patients who do complicate, present with non-specific symptoms. A 64-year-old female patient presented with a 2-month history of abdominal pain. Following clinical evaluation and computed tomography scan of the abdomen, a provisional diagnosis of colon cancer was made. Histology of the resected bowel at hemicolectomy demonstrated a perforation by fish bone with an associated abscess. The case illustrates how fish bone perforation may mislead unsuspecting clinicians and may be misdiagnosed as colonic cancer.

Gastrointestinal perforation caused by ingested fish bone. Computed tomography findings in 58 patients

CONTEXT AND OBJETIVE

Fish bones (FB) are the most commonly ingested objects and the most common cause of foreign body perforation of the GI tract. Patients present with varied and nonspecific clinical presentations. The inability to obtain a history of FB ingestion and its wide spectrum of nonspecific clinical presentations makes dietary FB perforation extremely difficult to diagnose, being a laparoscopic or surgical diagnosis. The aim of our study is to describe radiological features in CT that will alert you to look for the FB and then make an accurate presurgical diagnosis.

MATERIALS AND METHODS

All patients (n=58) with radiological diagnosis of gastrointestinal perforation caused by fish bone detected by CT between 2007 to 2017 were retrospectively reviewed. Inclusion criteria were: fish bone located beyond the esophagus, radiological diagnosis by CT and confirmation by surgery, endoscopy or radiological control. Descriptive analysis was made. Radiological features were studied including radioopaque foreign body, mural thickness, fatty infiltration or extraluminal air bubbles. Also potential complications were assessed.

RESULTS

There were 58 patients, 39 men and 19 women, with an average age of 70. Ileon was the most frequent site of perforation (20 patients). 100% showed regional fatty infiltration, 98% included foreign body, 45% had mural thickening and 20% localized extraluminal air bubbles. 15 abscess were found (3 in the liver) and just 5 showed pneumoperitoneum.

CONCLUSION

Fatty infiltration is the feature more common. Therefore, if fatty infiltration is seen in isolation radiologist should look for foreign body.

Appendicitis-mimicking presentation in fishbone induced microperforation of the distal duodenum: A case report

BACKGROUND

Upper gastrointestinal fishbone microperforations are rare and not commonly reported in medical literature. Despite the increasing use of computer tomography (CT) imaging and the employment of the Alvardo criteria, misdiagnosis of acute appendicitis can still occur. We report the rare case of an elderly Chinese gentleman who had a fish-bone induced microperforation of the duodenum that closely mimicked the symptoms of acute appendicitis.

CASE SUMMARY

This 79-year-old man presented with migratory lower abdominal pain that localized at his periumbilical region and right lower quadrant. He had associated pyrexia, general malaise and was noted to have an elevated white cell count. CT investigations initially revealed a distended appendix which was resected laparoscopically but showed no obvious signs of gross inflammation. The patient then deteriorated clinically and had increased oxygen requirements immediately after the surgery. This prompted further investigations. A further review of his CT scan revealed a fine fishbone microperforation in the distal duodenum associated with retroperitoneal abscess formation and seepage extending into the right lower quadrant. He was then started on broad spectrum intravenous antibiotics and subsequently underwent a laparotomy 12 h later to manage the obscure aetiology and to drain the abscess. The post-operative course was uneventful and he was discharged 11 d later including a 2-d stay in the intensive care unit.

CONCLUSION

This case offers an insight into a potential mimic of acute appendicitis and the diagnostic difficulties experienced in such presentations.

Successful treatment with laparoscopy-assisted surgery for ileal perforation due to an ingested foreign body: A report of two cases

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Small bowel perforation by an ingested foreign body (FB) is a rare abdominal emergency.

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Computed tomography scan is most effective but imperfect for diagnosis.

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Inquiring about FB ingestion and a high index of suspicion are very important.

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Laparoscopic surgery is effective even in this rare abdominal emergency.

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Extracorporeal handling of the affected small bowel is useful in this condition.

Introduction

Presently, the advantage of laparoscopic surgery is widely recognized and it is gaining popularity not only in elective abdominal surgeries but also in various kinds of emergent abdominal surgeries. This report describes two patients diagnosed with ileal perforation due to an ingested foreign body (FB)—a rare abdominal emergency—who were treated laparoscopically.

Presentation of case

Both patients were brought in by an ambulance to our hospital, with complaints of increasing lower abdominal pain. Computed tomography scan revealed a small bowel perforation due to an ingested FB in both patients, and laparoscopy-assisted partial ileal resection was immediately performed. Their postoperative recoveries were uneventful.

Discussion

Both patients with this rare abdominal emergency were successfully treated with laparoscopic surgery. Its feasible diagnostic and therapeutic abilities and decreased invasiveness contributed to their uneventful and fast recoveries. Extracorporeal handling of the affected small bowel via mini-laparotomy was useful in this setting as it was safe, fast, and cost-effective.

Conclusion

Laparoscopic surgery is effective, even for this rare abdominal emergency. Moreover, laparoscopy-assisted surgery accompanying mini-laparotomy is a rational treatment approach, especially for this condition.

Laparoscopic management of enterohepatic migrated fish bone mimicking liver neoplasm: A case report and literature review

RATIONALE

Accidental ingestion of a foreign body is common in daily life. But the hepatic migration of perforated foreign body is rather rare.

PATIENT CONCERNS

A 37-year-old man presented with a history of vague epigastric discomfort for about 2 months.

DIAGNOSIS

A diagnosis of the foreign body induced hepatic inflammatory mass was made based on abdominal computed tomographic scan and upper gastrointestinal endoscopy.

INTERVENTIONS

The patient underwent laparoscopic laparotomy. During the operation, inflammatory signs were seen in the lesser omentum and segment 3 of liver. B- Ultrasound guided excision of the mass (in segment 3) was performed. Dissecting the specimen revealed a fish bone measuring 1.7 cm in length.

OUTCOMES

The patient recovered uneventfully and was discharged on day 5 after surgery.

LESSONS

This study shows the usefulness of endoscopy for final diagnosis and treatment in foreign body ingestion. Early diagnosis and decisive treatment in time are lifesaving for patients with this potentially lethal condition.