Gastrointestinal perforation caused by ingested fish bone. Computed tomography findings in 58 patients

Abstract

Context and objectiveFish bones (FB) are the most commonly ingested objects and the most common cause of foreign body perforation of the GI tract. Patients present with varied and nonspecific clinical presentations. The inability to obtain a history of FB ingestion and its wide spectrum of nonspecific clinical presentations makes dietary FB perforation extremely difficult to diagnose, being a laparoscopic or surgical diagnosis.The aim of our study is to describe radiological features in CT that will alert you to look for the FB and then make an accurate presurgical diagnosis. Materials and methodsAll patients (n=58) with radiological diagnosis of gastrointestinal perforation caused by fish bone detected by CT between 2007 to 2017 were retrospectively reviewed. Inclusion criteria were: fish bone located beyond the oesophagus, radiological diagnosis by CT and confirmation by surgery, endoscopy or radiological control.Descriptive analysis was made. Radiological features were studied including radio-opaque foreign body, mural thickness, fatty infiltration or extraluminal air bubbles. Also potential complications were assessed. ResultsThere were 58 patients, 39 men and 19 women, with an average age of 70. Ileon was the most frequent site of perforation (20 patients). 100% showed regional fatty infiltration, 98% included foreign body, 45% had mural thickening and 20% localised extraluminal air bubbles. 15 Abscess were found (3 in the liver) and just 5 showed pneumoperitoneum. ConclusionFatty infiltration is the feature more common. Therefore, if fatty infiltration is seen in isolation radiologist should look for foreign body.