Sigmoid Colon Perforation Caused by an Ingested Fish Bone: A Case Report

Pyong Wha Choi^1,

¹Department of Surgery, Inje University College of Medicine, Ilsan Paik Hospital, 170, Juhwa-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-do, 10380, Korea

Cite this paper

Pyong Wha Choi. Sigmoid Colon Perforation Caused by an Ingested Fish Bone: A Case Report. American Journal of Medical Case Reports. 2016; 4(9):301-303. doi: 10.12691/AJMCR-4-9-2

Abstract

The accidental ingestion of a foreign body is common, and the majority of ingested foreign bodies pass through the gastrointestinal tract without complication. Perforation is one of the rarest complications and commonly occurs in the terminal ileum and recto-sigmoid junction. The sigmoid colon is an extremely rare site of perforation because of its anatomical features of a thick wall, large diameter, and non-angulation. Here, we present a case of sigmoid colon perforation caused by an ingested fish bone. A 56-year-old male patient presented with left lower abdominal pain. The patient had no past medical history and had eaten a steamed cod dish the day before presentation. His abdomen was slightly distended and the left lower abdomen was tender, with no signs of generalized peritoneal irritation. Computed tomography revealed a linear radio-dense foreign body protruding from the sigmoid colon lumen accompanied by infiltration and a small amount of free air. An emergency operation was performed. During the operation, a 4-cm-long fish bone (a portion of a fish head bone) was found protruding from the sigmoid colon. Intraoperative colonic lavage, primary resection, and anastomosis were performed. The postoperative course was uneventful, and the patient was discharged on the ninth postoperative day. The case represents an unusual case of sigmoid colon perforation caused by an ingested fish bone. Because colon perforation by ingested fish bone is extremely rare, and its preoperative diagnosis is difficult, meticulous history taking is crucial for the correct diagnosis and prompt management in the emergency setting.

Keywords

fish bone, foreign body, colon, perforation, history taking

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Mapelli P., Head L.H., Conner W.E., Ferrante W.E., Ray J.E, ¡°Perforation of colon by ingested chicken bone diagnosed by colonoscope,¡± Gastrointestinal Endoscopy, 26 (1). 20-21. February 1980.
[2]	Singh R.P., Gardner J.A, ¡°Perforation of the sigmoid colon by swallowed chicken bone: case reports and review of literature,¡± International Surgery, 66 (2). 181-183. June 1981.
[3]	Schwartz G.F., Polsky H.S, ¡°Ingested foreign bodies of the gastrointestinal tract,¡± The American Journal of Surgery, 42 (4). 236-238. April 1976.
[4]	Cho M.K., Lee M.S., Han H.Y., Woo S.H, ¡°Fish bone migration to the urinary bladder after rectosigmoid colon perforation,¡± World Journal of Gastroenterology, 20 (22). 7075-7078. June 2014.
[5]	Chiu J.J., Chen T.L., Zhan Y.L, ¡°Perforation of the transverse colon by a fish bone: a case report,¡± Journal of Emergency Medicine, 36 (4). 345-347. May 2009.
[6]	Goh B.K., Chow P.K., Quah H.M., Ong H.S., Eu K.W., Ooi L.L., Wong W.K, ¡°Perforation of the gastrointestinal tract secondary to ingestion of foreign bodies,¡± World Journal of Surgery, 30 (3). 372-377. March 2006.
[7]	Ngan J.H., Fok P.J., Lai E.C., Branicki F.J., Wong J, ¡°A prospective study on fish bone ingestion. Experience of 358 patients,¡± Annals of Surgery, 211 (4). 459-462. April 1990.
[8]	Coulier B., Tancredi M.H., Ramboux A, ¡°Spiral CT and multidetector-row CT diagnosis of perforation of the small intestine caused by ingested foreign bodies,¡± European Radiology, 14 (10). 1918-1925. October 2004.
[9]	Ward M.A., Tews M.C, ¡°Small bowel perforation secondary to fish bone ingestion managed non-operatively,¡± Journal of Emergency Medicine 43 (5). e295-298. November 2012.
[10]	Yamamoto M., Yamamoto K., Sasaki T., Fukumori D., Yamamoto F., Igimi H., Yamamoto H., Yamashita Y, ¡°Successfully treated intra-abdominal abscess caused by fish bone with perforation of ascending colon: a case report,¡± International Surgery 100 (3) 428-430. March 2015.