Extra luminal migration of ingested fish bone to the spleen as an unusual cause of splenic rupture: Case report and literature review

A case report of extremely rare case of fishbone penetration from stomach into spleen, causing splenic abscess, managed by spleen preserving surgery

INTRODUCTION

Fishbone penetrating from the stomach into the spleen, causing a splenic abscess, is an extremely rare condition.

CASE PRESENTATION

We report a case of fishbone penetration from the stomach into the spleen, presenting as a splenic abscess and acute peritonitis, diagnosed pre-operatively with a contrast-enhanced CT scan of the abdomen and subsequently managed with spleen-preserving surgery.

DISCUSSION

Fishbone penetration from the stomach into the spleen, causing a splenic abscess, which is an extremely rare occurrence. We successfully diagnosed and managed this case with spleen-preserving surgery, and the patient recovered well.

CONCLUSION

A rare case of fishbone penetration from the stomach into the spleen causing a splenic abscess was diagnosed radiologically pre-operatively and managed by a spleen-preserving procedure.

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.

Case report of abdominal left upper quadrant collection secondary to fish bone perforation

We present an unusual case of an intra-abdominal collection which evidenced a rare etiology and raises diagnostic particularities.

Background

Fish bones ingestion is frequent, but seldom followed by complications. Those are often reported at specific sites.

Objectives

This case report emphasizes the unusual presentation and site localization of a colonic perforation by a small fish bone, in the context of limited radiological accuracy at the diagnostic phase.

Case presentation

A 37 year old male was admitted to the gastroenterology ward with upper and left sided abdominal pain associated with fever and marked fatigue. His medical history was marked by a sleeve gastrectomy in 2010 for obesity. Abdominal signs and elevated acute inflammatory syndrome on blood tests were followed by computer tomography which revealed a pericolic mass near the left splenic flexure. The pain and fever increased in intensity, so a laparotomy was proposed. Intraoperatively, a tumor-like lesion was found and a resection with oncologic limits was performed. Microscopic examination of the specimen revealed a fish bone, but only after surgery did the patient confirm that he had eaten fish meal the week before. The post-operative period was uneventful.

Conclusion

Fish bones remain some of the most frequently ingested alimentary foreign bodies; they may cause atypical clinical presentations, frequently omitted by the patients themselves if symptoms appear delayed. They could also lead to possible high-risk complications which need to be addressed by surgeons.

Porta hepatis abscess and portal vein thrombosis following ingestion of a fishbone

A man in his late 50s presented to the emergency room with a 1-month history of severe abdominal pain and an endoscopic fishbone retrieval from his rectum. Serial CT scans revealed a fishbone located in the patient's upper abdomen, which had migrated through the stomach wall, into the periportal space, causing a contained gastric perforation, development of a porta hepatis abscess and secondary portal vein thrombosis. Furthermore, the sharp tip of the fishbone lay 5 mm from the patient's hepatic artery. He was transferred to a hepatobiliary centre where he underwent urgent exploratory laparotomy, with surgical exploration of the porta, drainage of the abscess and retrieval of the fishbone. Postoperatively, he received further treatment with antibiotics and anticoagulation and recovered without further sequelae.

A migratory shark bone

Fish bone ingestion is a common presentation in ENT. If not managed correctly, it can cause serious complications for the patient and dilemmas for the clinician. A 49-year-old Sri Lankan woman presented to the emergency department following shark bone ingestion with a 'pricking' sensation in her throat. After initial investigation, the bone migrated through to the sternocleidomastoid muscle. After surgical removal of the shark bone she went on to develop a large neck collection, which required surgical drainage. The careful attention to the patient's history and use of imaging facilitated treatment in this case of fish bone ingestion and management of the sequelae.

Usual suspects: the foreign bodies of the aerodigestive tract

This case series is about four different foreign bodies lodged in different locations of the aerodigestive tract. All four cases had delayed diagnosis due to inconspicuous history. Radiology in the form of computed tomography aided the appropriate diagnosis in most of these cases. Though all four patients have been successfully managed by removal of foreign body, not all of them have identical outcomes. A brief discussion about predictive factors in the fish bone foreign body has been included. The authors also discuss certain critical aspects of the management, which may aid in reducing the morbidity. We emphasise on the high index of suspicion in peculiar cases and on the low threshold for radiological investigation in doubtful clinical scenarios.