Small bowel perforation caused by a fish bone

Case contributed by Lam Van Le
Diagnosis certain

Presentation

Right iliac fossa pain. Blood tests revealed an elevated white blood cell count and increased percentage of neutrophils.

Patient Data

Age: 50 years
Gender: Male
This study is a stack
Axial
non-contrast
This study is a stack
Sagittal
non-contrast
This study is a stack
Coronal
non-contrast
This study is a stack
Axial C+ portal
venous phase
Coronal
3D
Oblique
3D
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Info

A rod-shaped structure approximately 2 cm long and 3 mm thick, with pointed ends, was located within the small bowel in the right iliac fossa. One pointed end was embedded in the bowel wall, causing thickening and edema of the corresponding bowel segment, with mild surrounding fat infiltration.

No free air or fluid was noted in the abdominal cavity. No abnormalities were observed in other organs.

Surgical report:

  • the ileal loops in the right iliac fossa were inflamed and congested. A sharp foreign object was observed penetrating the intestinal wall, with fibrinous exudates surrounding the perforation site

  • examination of the ileal loop revealed a sharp, horizontally positioned foreign object penetrating through both walls of the ileum, approximately 140 cm from the ileocecal junction

  • the sharp foreign object, identified as a fish bone, was removed from the ileum. Both perforation sites in the ileum were inspected. The perforations were closed with X-shaped sutures using Vicryl

Case Discussion

The imaging and surgical findings are consistent with small bowel perforation caused by a fish bone.

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