Bowel perforation - fish bone

Case contributed by Bahman Rasuli
Diagnosis almost certain


Toothless old man with swallowing of fish bone accidentally 5 days ago and now presented with progressive worsening of abdominal pain.

Patient Data

Age: 65 years
Gender: Male

Small pockets of pneumoperitoneum are seen in the right subdiaphragmatic space, mainly anterior to the liver, indicating bowel perforation.

In the rectosigmoid region, there is a 3 cm long linear density due to fish bone in the lumen of the loop traversing the bowel wall with adjacent pericolic fat stranding and locules of extraluminal air.

No collection.

Renal cortical cysts are seen on both sides.

Case Discussion

Bowel perforation is a rare complication of ingested foreign bodies. Fishbone is one of the most common causes of bowel perforation in these cases and the most common sites of perforation are the terminal ileum, duodenum, and rectosigmoid.

CT is more sensitive than plain films in the detection of ingested fish bones.

In this case, the patient was operated and the finding was confirmed postoperatively.

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