Small bowel perforation by chicken bone

Case contributed by Dr Bruno Di Muzio

Presentation

Patient presents to the emergency room with diffuse abdominal pain for several hours. No fever, rigid abdomen.

Patient Data

Age: 68
Gender: Female
CT

CT Abdomen and pelvis

It is possible to observe a sharp structure with bone attenuation piercing the wall of a small bowel loop.

Case Discussion

The patient underwent emergency surgery, and the cause of the perforation was identified as a piece of chicken bone.

Most foreign bodies pass through the gastrointestinal tract without any consequence. A very small percentage perforate the bowel, leading to acute abdomen and requiring surgical intervention. In most cases, the cause is discovered perioperatively. Foreign bodies such as dentures, fish bones, chicken bones, toothpicks and cocktail sticks have been known to cause bowel perforation 1.

An abdominal radiograph is rarely helpful in making a diagnosis preoperatively, however a CT scan of the abdomen is considered the most useful imaging to detect foreign bodies or complications arising from them. The most common site of perforation is the terminal ileum and colon, although an increased incidence of perforation has been reported in association with Meckel's diverticulum, the appendix, and diverticular disease1.

Differential diagnosis:
    •    appendicitis
    •    diverticulitis

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Case information

rID: 14920
Case created: 5th Sep 2011
Last edited: 6th Sep 2015
Inclusion in quiz mode: Included

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