Small bowel perforation due to chicken bone, with incidental gastric leiomyoma
Presentation
Developmental delay. Abdominal pain. Recent consumption of chicken wings.
Patient Data
Presentation
Delayed phase images were obtained due to motion on portal venous phase. Portal venous phase imaging is included in this case to highlight the gastric findings.
Best seen on delayed phase imaging, there is focal thickening and hyperemia associated with a loop of small bowel in the right lower abdomen. A bone fragment can be seen within the bowel lumen, with the pointed edges of the fragment protruding into the wall. Proximally, an additional fragment of thin bone can be seen within the small bowel lumen.
On the portal venous phase imaging, there is a round intramural mass in the gastric fundus. It has peripheral enhancement and central low attenuation. At the time of initial imaging, this was felt to represent a focal intramural perforation/abscess in the stomach due to the ingestion of chicken bones.
Specimen: Small bowel with bone
Diagnoses:
Small intestine, resection - Segment of small intestine harboring two fragments of bone consistent with ingested foreign bodies, complicated by acute enteritis with ulceration, perforation, and intramural abscess.
1 month follow-up
Distal esophageal distention by ingested material, likely food impaction. Persistent peripherally enhancing, centrally low attenuation intramural mass in the gastric fundus. Changes of small bowel resection from chicken bone perforation. No other acute findings.
Case Discussion
This case provides a great example of small bowel perforation due to chicken bone ingestion. There are two separate fragments of chicken bone within the small bowel, both of which were present in the pathologic specimen.
What makes this case particularly interesting is the mass in the gastric fundus. Given that it had peripheral enhancement and central low attenuation, an intramural abscess or perforation was favored due to the ingestion of chicken bones. However, this finding persisted on the follow-up study, which made it suspicious for mesenchymal neoplasm such as gastrointestinal stromal tumor. The final pathologic diagnosis is gastric leiomyoma, with abscess and inflammation.
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