Abstract
IntroductionGastrointestinal perforation due to a foreign body is not unknown. The foreign body often mimics another cause of acute abdomen and requires emergency surgical intervention. The majority of patients do not recall ingesting the foreign body. Perforations have been reported to occur in a pathologically abnormal colon.Case presentationWe report an interesting case of a 47-year-old Caucasian man who had a perforation of the sigmoid colon caused by an ingested chicken bone mimicking acute appendicitis. Our patient presented with right iliac fossa pain and local tenderness. When a laparotomy was performed, a chicken bone was found protruding through the sigmoid colon, which was found to lie in the right iliac fossa, thus mimicking acute appendicitis. Our case is different from previously reported cases in that perforation occurred in a non-pathological colon.ConclusionOur case emphasises the fact that the operating surgeon has to be aware of various differential diagnostic possibilities which mimic acute appendicitis. This has implications on the training of junior surgeons who are often involved in performing these procedures, and may do so out of hours. Care needs to be taken while obtaining consent for the necessary operation.
Highlights
Gastrointestinal perforation due to a foreign body is not unknown
Case presentation: We report an interesting case of a 47-year-old Caucasian man who had a perforation of the sigmoid colon caused by an ingested chicken bone mimicking acute appendicitis
When a laparotomy was performed, a chicken bone was found protruding through the sigmoid colon, which was found to lie in the right iliac fossa, mimicking acute appendicitis
Summary
Sigmoid colonic perforation is an acute surgical emergency, the most common cause of which is diverticular disease. Patients present with left iliac fossa pain, raised inflammatory markers and localised peritonitis. Earlier case reports of traumatic perforation of the sigmoid colon emphasise the presence of a background pathology such as diverticular disease, cancer or a fistula. Sigmoid mobility can result in pathologies and present as acute appendicitis. This clearly causes diagnostic confusion and can present a challenge especially to a trainee-grade surgeon. Case presentation A 47-year-old Caucasian man presented with a 3-day history of colicky generalised abdominal pain, gradually getting worse, eventually localising to the right iliac fossa. Abdominal examination showed localised tenderness and guarding in the right iliac fossa.
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