Penetrating Fish Bone in the Stomach: A Rare Cause of Acute Abdomen Diagnosed Early Using Ultrasound

Abstract

Abdominal ultrasound is a widely-used tool for screening various abdominal emergencies. Common abdominal emergencies, such as cholecystitis, pancreatitis, appendicitis, aortic aneurysm, and intra-abdominal bleeding, can be easily diagnosed using ultrasound. Foreign body ingestion is another common emergency that requires timely diagnosis and treatment to prevent delayed complications. Diagnosis of foreign body ingestion is easy when its typical history is reported. However, diagnosis of clinically-unsuspected fish bone ingestion is difficult and is usually only possible after complications develop. Here, we report a 66-year-old woman with a history of hypertension who presented to our emergency department with abdominal pain after a meal for 1 day. She did not remember having any discomfort during swallowing or ingestion of any abnormal material by mistake during the previous 1 week. Abdominal ultrasound examination suggested the presence of a penetrating fish bone in the gastric antrum without local complications. Upper endoscopy was performed immediately and the fish bone was successfully removed. Although fish bone ingestion can be easily diagnosed by computed tomography, previous studies using ultrasound for diagnosis of fish bone ingestion are limited, and all cases were diagnosed after complications had occurred. To the best of our knowledge, this is the first case of clinically-unsuspected fish bone ingestion diagnosed using ultrasound before any complications developed.