Ingested fish bone with gastrointestinal perforation

Case contributed by Dario Giambelluca
Diagnosis certain


Patient presented to the emergency department complaining of diffuse abdominal pain.

Patient Data

Age: 80 years
Gender: Female

Small pockets of pneumoperitoneum are seen in the supramesocolic space, mainly anterior to the liver, indicating perforation of the upper gastrointestinal tract.

In the second part of the duodenum there is a 4 cm long linear density: after that CT scan was performed, we asked the patient what she had eaten for dinner and we deduced that it was an ingested fish bone, which is the probable cause of small bowel perforation. Another smaller fish bone is evident in the lumen of a loop of mid-distal ileum in the right iliac fossa.

Orange arrow indicates suspected fishbone in the duodenum.

Blue arrow indicates a second fishbone in the ileum.

Case Discussion

Gastrointestinal perforation is a rare complication of ingested foreign bodies. Fish bones are the most common cause of 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 detection of ingested fish bones.

In this case the patient was observed with conservative treatment and recovered without further complication.

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