A CASE OF STRANGULATED ILEUS CAUSED BY AN INGESTED FISH BONE PENETRATING THROUGH THE APPENDIX TO ILEUM

Abstract

A 55-year-old man was admitted to the hospital because of sudden onset of right lower abdominal pain. Physical examination revealed severe tenderness with muscle guarding and peritoneal signs in the right lower abdomen. Abdominal simple x-ray films showed air fluid level formation in the small intestine. He underwent an emergency operation under a diagnosis of strangulated ileus. At laparotomy, the appendix adhered to the small intestine at about 150cm to the ileum end, which caused strangulation of the small intestine involving about 50cm in length. An appendectomy and a partial resection of the small intestine which was penetrated by a fish bone were performed. The strangulation was relieved by appendectomy and then the circulation to the small intestine was restored. Therefore, strangulated loop of the small intestine was not resected. Retrospectively, we reviewed abdominal CT scans taken when he was admitted and confirmed a linear calcified foreign body as a fish bone. It is rare that ingested fish bone perforates or penetrates the gastrointestinal organs, especially the appendix. This case is believed very rare that the penetration of the appendix by a fish bone caused strangulated ileus.