Fish bone perforation mimicking colon cancer: A case report

Accidental Fish Bone Ingestion Leading to Gastric Perforation: A Diagnostic Challenge

Accidental ingestion of animal bones, including fish bones, often goes unnoticed and rarely leads to acute medical complications. However, in rare cases, fish bones can perforate the gastrointestinal tract, causing serious complications such as perforation, abscess formation, or fistula development, necessitating emergent surgical intervention. This case report describes a rare case of gastric perforation by a fish bone ingestion, complicated by perigastric and hepatic abscesses. The patient initially presented to a rural emergency department with acute abdominal pain, where limited imaging resources posed a diagnostic challenge. After repeated rural emergency department presentations, a definitive diagnosis was only established after the patient was transferred to a tertiary center and evaluated using computed tomography (CT) imaging. This helped to guide appropriate surgical management, and an emergency laparotomy was performed, which was followed by an uneventful recovery. We emphasize the critical role of CT imaging in diagnosing fish bone perforation, discuss common sites of perforation, and highlight the need to consider this pathology as a differential diagnosis in patients with undifferentiated abdominal pain.

Unforeseen consequences: A case report of misdiagnosis in pediatric ingestion of a fish bone

Children are frequently reported as cases of foreign body ingestion, with fishbone ingestion being particularly prevalent in communities where fish consumption is common. Although many instances of foreign body ingestion resolve spontaneously, the ingestion of sharp objects like fishbones poses a greater risk of morbidity and mortality due to their propensity for causing complications. Furthermore, incidents of foreign body ingestion often present with nonspecific symptoms or may go unnoticed, potentially leading to misdiagnosis and complicating the clinical course. We present a case of a 2-year-old boy initially misdiagnosed with constipation and treated with laxatives due to intermittent progressive abdominal pain. Subsequently, he presented to the emergency department where radiological and laboratory investigations revealed signs of inflammation and localized abdominal fluid collection containing a linear hyperdense object, indicating complicated foreign body ingestion with perforation. Urgent laparotomy revealed an omental abscess, which was excised, and the perforation site was repaired with sutures. This case underscores the risk of misdiagnosis and the importance of timely recognition and management. It also emphasizes the critical role of imaging, particularly computed tomography, in accurate diagnosis and differentiation from other common conditions.

Effect of miR-488 on Colon Cancer Biology and Clinical Applications

Objective

To explore the expression levels of miR-488, miR-29c-3p, and growth differentiation factor 15 (GDF15) in colon cancer tissue and analyze their relationship with clinicopathological features in patients with colon cancer.

Methods

The study was conducted from November 2012 to November 2020. A total of 200 patients with colon cancer were treated in our hospital during this period. During the operation, the colon cancer tissues and the adjacent tissues whose distance from the cancer tissues were more than 5 cm were collected, and the expression levels of miR-488, miR-29c-3p, and GDF15 mRNA in colon cancer tissues were detected by qRT-PCR (real-time fluorescence quantitative). The relationship between them and the clinicopathological features and prognosis of patients with colon cancer were analyzed and discussed.

Results

The level of miR-488 in colon cancer tissues was lower than that in adjacent tissues, but the levels of miR-29c-3p and GDF15 mRNA in colon cancer tissues were higher than those in adjacent tissues (P < 0.05). Compared with paracancerous tissues, the expression rates of miR-29c-3p and GDF15 protein were higher in colon cancer tissues (P < 0.05). There was no difference in age, sex, tumor location, and tumor diameter between high expression of miR-488 group and low expression of miR-488 group (P > 0.05). The degree of differentiation, depth of invasion, TNM stage, lymph node metastasis, and other factors have a direct impact on the level of miR-488 and the expression of miR-29c-3p (P < 0.05). The depth of invasion, TNM stage, and lymph node metastasis could affect the expression of GDF15 in patients with colon cancer (P < 0.05).

Conclusion

miR-488, miR-29c-3p, and GDF15 in colon cancer tissue are related to the clinicopathological features of patients in varying degrees and may become markers after early warning of colon cancer, which can provide effective guidance for clinical diagnosis and treatment.

A rare case of perforation of a colorectal tumor by a fish bone

The accidental ingestion of foreign bodies is a common clinical issue. While most foreign bodies pass through the gastrointestinal (GI) tract without complications, a few cases unfortunately result in GI perforation. Fish bones are one of the most frequent foreign bodies found in the GI tract, and they are high-risk objects for GI perforation due to their hard and sharp-pointed ends. Here, we present a rare case of a 64-year-old man with perforation of a colorectal tumor by a fish bone. The patient received emergency Hartmann's operation with lymph node dissection. Although the patient experienced recurrence in the liver rather than peritoneal dissemination, systemic chemotherapy was considerably effective, and conversion therapy with hepatectomy was successfully performed; the patient achieved 5-year relapse-free survival after the operation. To our knowledge, this is the first report of the perforation of a GI tumor by a fish bone. This rare case suggests the significant clinical implication that proper preoperative diagnosis and prompt surgical treatment lead to better postoperative outcomes for patients with tumor perforation by a foreign body.

Fish bone perforation of the small bowel: A case report

INTRODUCTION

Fish bone is one of the most common accidently ingested foreign bodies. Normally, it is eliminated from the gastrointestinal (GI) system without any symptomatology, only 1% of the cases will develop a perforation of the GI tract requiring surgical intervention.

PRESENTATION OF CASE

A 70-year-old man, presented with a 48h evolving abdominal pain, important abdominal distension, nausea, vomiting, and a last bowel movement reported 2 days ago, The abdomino-pelvic CT-scan objectified a distension of the terminal ileum measured at 30mm, The exploration revealed a sharp foreign body,at the 15 proximal centimeters of the terminal ileum, which penetrated through the wall of the ileum. The foreign body was removed and we noticed that it is a fish bone. The patient recovered well.

DISCUSSION

Clinical manifestations are determined by the location of the perforation and the preoperative diagnosis is always difficult to reach. Computed tomography (CT) scan is the indicated method to identify ingested foreign bodies and surgery is the treatment of choice.

CONCLUSION

Delay in diagnosis and treatment can be associated with significant morbidity and mortality.