|
| |
 |
|
| CASE REPORT |
|
| Year : 2022 | Volume
: 18
| Issue : 4 | Page : 136-138 |
|
Ileal perforation by ingested fishbone
Debarpito Mukherjee1, Paramita Thander1, Sayantan Rout2, Pankaj Halder3
1 Department of General Surgery, R G Kar Medical College, Kolkata, West Bengal, India
2 Department of Anesthesiology, R G Kar Medical College, Kolkata, West Bengal, India
3 Department of Pediatric Surgery, R G Kar Medical College, Kolkata, West Bengal, India
| Date of Submission | 08-Nov-2022 |
| Date of Acceptance | 01-Feb-2023 |
| Date of Web Publication | 20-Feb-2023 |
Correspondence Address:
Dr. Pankaj Halder
Department of Pediatric Surgery, R G Kar Medical College, Saroda Pally, Baruipur, Kolkata 700144, West Bengal
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/AMJM.AMJM_45_22
Hollow viscus perforation is one of the most frequent causes of acute gastrointestinal symptoms, but these are rare due to foreign body (FB) ingestion. The majority of ingested FBs that reach the stomach pass uneventfully through the gastrointestinal tract. Hollow viscus perforation following a FB ingestion frequently occurs at the ileum. Fishbones are often ingested by older population, and only a small number of patients can recall an event of swallowing an FB. Here, we present a case of ileal perforation caused by ingesting a fishbone in a 60-year-old man who recovered successfully after receiving emergency surgical treatment. Keywords: Emergency, fishbone, foreign body, ileum, perforation
How to cite this article:
Mukherjee D, Thander P, Rout S, Halder P. Ileal perforation by ingested fishbone. Amrita J Med 2022;18:136-8 |
| Introduction | |  |
Fishbones are the main foreign objects that lead to gastrointestinal perforations. Since the clinical history and imaging evidence are frequently lacking, it is difficult to determine preoperatively that the intestinal perforation is caused by a fishbone. Additionally, the majority of fishbones readily travel through the digestive tract without having any negative consequences.[1] When treating individuals with suspected gastrointestinal perforations who do not exhibit the typical symptoms on routine imaging, a high level of suspicion is required because fishbones could be the cause. contrast enhanced computed tomography can be suggested to help with the diagnosis, although it has a limited ability to detect fishbones. The majority of studies advise early surgical intervention to prevent sepsis and issues caused by migrating fishbones[2] We describe a 60-year-old man who had an ileal perforation following ingestion of a fishbone. The perforation was successfully repaired after an early laparotomy to prevent the progression of peritonitis and sepsis.
| Case Report | | |
A 60-year-old man came to our emergency department with a complaint of abdominal pain for the last one day. The patient had no history of smoking or drinking. There was no substantial history of dyspepsia or prolonged fasting. Additionally, he has not disclosed any recent fever history. The possibility of tuberculosis in the past was likewise eliminated. Examining the abdomen revealed generalized tenderness, rigidity, and features of peritonitis. An abdominal straight X-ray revealed gas under the diaphragm, indicating a perforated hollow viscus [Figure 1]. He was assigned for an exploratory laparotomy after the initial resuscitation. When the abdomen was opened, pus leaked out and the omentum was discovered to be tightly attached to the duodenum and gallbladder, but there was no duodenal perforation. After a comprehensive examination of the entire gut, a small (2 × 2) mm perforation was noted at the ileum at its mesenteric border and another micro-perforation was found just beside it. Omental fat creeping was also observed along with this, raising the possibility of Chron’s disease. However, the healthy condition of the rest of the intestines and the lack of a supportive history led to a diagnostic conundrum. After closer inspection, a thin, hard object was felt distal to the perforation inside the intestine; upon removal, the object was discovered to be a 5-cm-long fishbone with sharp edges [Figure 2]. The patient underwent primary repair of the perforation with 3-0 polydioxanone suture, and the recovery went smoothly. On the fifth postoperative day, the patient was able to tolerate an oral diet, and on the tenth, he was released. On day 14, he was checked at the surgical follow-up clinic and found him to be doing well. During a subsequent interview after surgery, the patient admitted that a hard fishbone had accidentally been ingested. | Figure 1: A straight X-ray reveals gas under the diaphragm, indicating a perforated hollow viscus following fishbone ingestion in a 60-year-old man
Click here to view |
 | Figure 2: An intraoperative image of a 60-year-old man reveals a perforation at the ileum at its mesenteric border caused by a 5-cm-long fishbone with sharp edge
Click here to view |
After recovering from surgery, during a subsequent interview, the patient admitted that he had unintentionally ingested a hard fishbone. Additionally, a forensic study of the specimen that was recovered during the laparotomy suggested the same thing.
| Discussion | | |
Ingestion of foreign body (FB) by accident or without awareness is rather prevalent. Most of these FB pass through the digestive tract without causing any problems; blockage and/or perforation only occasionally occur. Most ingested fishbones that reach the stomach typically pass through the digestive system without any difficulties.
The majority of cases occur in children. And only 1% of the patients require surgical intervention depending upon nature, size, and shape of the FB.[3] This catastrophe is frequently observed in particular patient populations, including those with psychiatric illnesses, drinkers, drug users, or elderly people wearing dentures.
Importantly, the majority of individuals do not recollect the actual event of ingesting any FB. Additionally, the condition might occasionally closely resemble other acute abdomen-related conditions, necessitating an urgent surgical intervention. Intestinal obstruction is a rare and unusual occurrence; in contrast, perforation is very common and is well described in the literature.[4] Our patient arrived with intense abdominal discomfort and peritonitis-like symptoms. An abdominal straight X-ray revealed gas under the diaphragm. Hollow viscous perforation was thus diagnosed, although no relevant history was known.
When there is gastrointestinal tract perforation due to FB, there is a leak of intraluminal contents into the peritoneal cavity that results in peritonitis. A timely assessment is necessary since delaying surgical treatment frequently leads to high fatality. It may be possible to identify a cause based on the location of the perforation (e.g., an ileal perforation in Crohn’s disease, a jejunal perforation in celiac disease, or a perforation worsened by lymphoma or collagenous sprue).[5] Duodenal perforations are typically caused by chronic duodenal ulceration that frequently occurs in people who have a history of smoking, drinking, prolonged fasting, and persistent dyspepsia.
Blunt abdominal trauma is another common cause of traumatic intestine perforation. Ileal perforations are related with histories of typhoid fever, tuberculosis, Chron’s illness, celiac sprue, etc.[6]
In our case, a diagnosis of hollow viscus perforation was made prior to surgery, but because there was no suggestive history, the perforation was proven to be caused by fishbone only after exploration. Despite technological advancements, plain film radiography should still be the initial imaging test for suspected intestinal obstruction or perforation. An ultrasonography is frequently the first test used to assess the female patient with right lower quadrant or pelvic pain. The invention of helical computed tomography (CT) imaging has been the most important development in imaging of the acute abdomen over the past ten years. The preferred diagnostic tool for visualizing the surgical abdomen is still CT. Despite the rarity of spontaneous free perforation of the small intestine, computed tomographic imaging has made it easier to identify the precise cause.[7] Though technological developments enable faster imaging, the present level of accessibility in the acute condition prohibits the widespread use of magnetic resonance imaging.
Author contribution
Debarpito Mukherjee: Drafting the article
Paramita Thander: Acquisition of data or analysis and interpretation of data
Sayantan Rout: Revising it critically for important intellectual contents.
Pankaj Halder: Final approval of the version to be published.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Munasinghe BM, Karunatileke CT, Rajakaruna RARMLN, Senevirathne PSMB, Dhanuksha DC A fatal perforation of the distal ileum from an ingested fish bone: A case report. Int J Surg Case Rep 2022;96:107331.  |
| 2. | Kuo CC, Jen TK, Wen CH, Liu CP, Hsiao HS, Liu YC, et al. Medical treatment for a fish bone-induced ileal micro-perforation: a case report. World J Gastroenterol 2012;18:5994-8. |
| 3. | Sarwa P, Dahiya RS, Nityasha , Anand S, Chandrabhan , Gogna S, et al. A curious case of foreign body induced jejunal obstruction and perforation. Int J Surg Case Rep 2014;5:617-9. |
| 4. | Reeves JM, Wade MD, Edwards J Ingested foreign body mimicking acute appendicitis. Int J Surg Case Rep 2018;46:66-8. |
| 5. | Shin D, Rahimi H, Haroon S, Merritt A, Vemula A, Noronha A, et al. Imaging of gastrointestinal tract perforation. Radiol Clin North Am 2020;58:19-44. |
| 6. | Beecher SM, O’Leary DP, McLaughlin R Diagnostic dilemmas due to fish bone ingestion: Case report & literature review. Int J Surg Case Rep 2015;13:112-5. |
| 7. | Freeman HJ Spontaneous free perforation of the small intestine in adults. World J Gastroenterol 2014;20:9990-7. |
[Figure 1], [Figure 2]
|
Search Pubmed for