Small bowel perforation - fish bone

Case contributed by Dr Michael P Hartung

Presentation

Progressively worsening abdominal pain over past few weeks.

Patient Data

Age: 80 years
Gender: Male

3 cm in length linear, dense foreign body within the loop of small bowel in the right mid abdomen. The foreign body traverses the bowel wall. Adjacent to this are a few locules of extraluminal air with small amount of fluid.

Prior right hemicolectomy. No other acute findings.

TISSUES: SMALL INTESTINE - SEGMENT OF SMALL BOWEL

PRE-OP DIAGNOSIS: Perforated viscus

POST-OP DIAGNOSIS: Same.

GROSS:

Received in formalin is an 11 cm segment of small bowel with attached mesentery measuring up to 3.5 cm in thickness. The bowel has serosal adhesions and fibrinopurulent exudate which is concentrated along the mesenteric area. Present in the center of this exudate is an apparent perforation. The mucosa otherwise appears normal. The mesenteric fat is focally hemorrhagic and indurated. No foreign body is noted.

DIAGNOSIS:

Small bowel segment, resection:

  • perforation with acute inflammation and acute serositis
  • patchy acute mucosal inflammation
  • serosal adhesions
  • mesenteric acute inflammation with abscess formation

 

Case Discussion

This case provides a grade example of small bowel perforation due to foreign body. The appearance of the foreign body is characteristic of perforation by a thin bone fragment (most commonly a fish bone). Curiously, no foreign body was identified at the time of gross pathology, however, the CT findings of foreign body perforation are very convincing.  

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Case information

rID: 59831
Published: 1st May 2018
Last edited: 1st May 2018
Inclusion in quiz mode: Included

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