A fatal perforation of the distal ileum from an ingested fish bone: A case report

Small bowel perforation caused by a fish bone in a patient with vascular Ehlers-Danlos syndrome: a case report

Management of gastrointestinal perforation in patients with vascular Ehlers-Danlos syndrome (vEDS) is clinically challenging. A male in his 40s with vEDS presented with right lower abdominal pain. Computed tomography revealed a foreign body in the ileum with bowel perforation. A detailed inquiry revealed that he had consumed codfish six days prior. Based on these findings, he was diagnosed with a small bowel perforation caused by a fish bone. Emergency laparotomy was performed and intraoperative findings showed a fish bone in the ileum penetrating the mesentery. We resected ~5 cm of the small intestine, including the perforation site. Although the patient experienced postoperative paralytic ileus, he was discharged on postoperative Day 27. Gastrointestinal perforation caused by fish bones in patients with vEDS is extremely rare and requires careful assessment to determine the appropriate treatment. For surgeons, an individualized surgical strategy and optimal perioperative management are important to prevent fatal complications.

Fishbone Foreign Body Ingestion With Gastric Impaction and Intestinal Micro-perforation in an Adult Female: A Case Report

Foreign body ingestion of fishbones is a very common complaint where most foreign bodies travel safely through the gastrointestinal tract (GIT) without any serious complications. However, its clinical presentation is nonspecific, and its clinical severity can vary widely, thus requiring the use of conservative and or invasive treatment modalities. In this case report, we present a case of a 42-year-old female who reported eating fish two days prior to presenting with upper gastrointestinal tract (GIT) foreign body impaction in addition to a lower GIT micro-perforation secondary to fishbone ingestion, both of which were successfully managed with conservative, nonsurgical treatment modalities. Impaction, perforation, or obstruction of fishbone foreign bodies often occur at GIT angulations or narrowing. Clinical diagnosis of foreign body ingestion requires the use of multiple modalities such as a detailed history, physical exam, radiographic evaluation, and endoscopic evaluation as needed. Treatment depends on multiple factors and can be conservative or surgical in nature. Fishbone foreign body ingestion is a common complaint and rarely leads to severe complications. However, its diagnosis can be difficult without an explicit history highlighting ingestion of fishbones and requires the use of appropriate imaging modalities such as computed tomography (CT) scans. Subsequent management may require conservative or invasive treatment modalities based on the location of the fishbone, and the presence or absence of accompanying complications such as peritoneal signs, sepsis, and radiographic identification of bowel perforation.

A fatal aorto-oesophageal fistula due to a mutton bone: A case report

INTRODUCTION AND IMPORTANCE OF THE CASE

Aorto-oesophageal fistula (AEF) following foreign body ingestion is rare and conservative management is always fatal. The delayed presentation further confounds poor outcomes.

PRESENTATION OF CASE

A 46-year-old South-Asian woman presented with pain and difficulty in swallowing following ingestion of a mutton-containing meal. The patient refused urgent upper GI endoscopy and was initially managed conservatively on the basis of the resolution of symptoms and hemodynamic stability and was discharged home. On review a week later, the patient did not consent to a UGIE. She presented the next day with a severe upper GI bleed. Due to profuse haemorrhage, a bleeding point could not be identified, and she suffered a cardiac arrest. Attempts at resuscitation were unsuccessful. The autopsy revealed an AEF caused by a sharp mutton bone lodged in the lower oesophagus.

CLINICAL DISCUSSION

High-risk food bolus impactions such as the ones caused by sharp objects need urgent endoscopy to confirm the position and extraction if safe. AEF occurs with time and could result in massive haemorrhage and mediastinitis. Endoscopic stenting, thoracoscopic surgery, and open repair are methods of emergent and definite management that still carry significant mortality.

CONCLUSION

Management of AEF requires early diagnosis with a high index of suspicion, endoscopic and CT-based angiography studies, and surgical interventions tailored to patients based on the available expertise. High-risk patients should be similarly educated on the probable complications and the symptomatology.