Jejunal perforation by fishbone

Abstract

Foreign body ingestion is a common presentation in clinical practice. Although most ingested foreign bodies pass uneventfully across the gastrointestinal tract, sharp elongated objects pose a greater risk of intestinal perforation. We report here a case of jejunal perforation following the ingestion of fishbone. A 78-year-old female presented with acute onset of generalised abdominal pain for few hours. Examination revealed tenderness, guarding and rigidity all over the abdomen. Erect Abdominal X-ray findings were inconclusive. However, contrast-enhanced computed tomography (CT) showed a thin, linear hyperdense foreign body perforating through the jejunum. Exploratory laparotomy was done, and a fishbone piercing the small bowel 50 cm distal to the ligament of Treitz was retrieved. The perforation hole was closed with primary suture. Postoperatively, the patient recovered well. Small bowel perforation is a life-threatening emergency that necessities urgent surgical intervention. Fishbones are commonly associated with perforations and the most common site of perforation is the terminal ileum. The most important risk factor associated with intestinal perforation by fishbones is the use of dentures which impair protective sensory mechanisms. Clinical presentation can be non-specific, and contrast-enhanced CT is required to establish diagnosis. Intestinal perforation associated with foreign body ingestion should be considered when evaluating patients with acute abdomen.