COLONIC PERFORATION CAUSED BY A FISH BONE: A CASE TREATED BY AN ENDOSCOPIC PROCEDURE

Abstract

Gastrointestinal perforation /penetration by an accidentally ingested fish bone has often been reported in Japan. Surgical intervention, such as traditional open surgical procedures including removal of the fish bone and colectomy, is widely accepted to prevent peritonitis, even though the inflammatory impact of the perforation /penetration is localized in the abdominal cavity. A 49-year-old man, presenting with complaints of acute abdominal pain, was referred to the surgical department. On admission, his vital signs were stable and his physical examination was unremarkable except for epigastric tenderness to palpation with a slight peritoneal sign. Abdominal computed tomography (CT) examination revealed a linear, high-density signal measuring 3 cm, protruding from the lumen through the wall of the transverse colon with a very small amount of free air, suggesting a fish bone penetrating the transverse colon. Based on the findings of these examinations, the patient was diagnosed as having transverse colon perforation caused by a fish bone. After conservative treatment with fasting and antibiotic administration for several days, the fish bone penetrating the colon was retrieved by an endoscope using grasping forceps. His subsequent course was favorable, and he was discharged without any problems on the third day after endoscopy. This clinical case allows us to discuss the alternative endoscopic treatment method, instead of an emergency surgical approach, for colonic perforation/penetration caused by a fish bone. We here report a case of transverse colon perforation by a fish bone that was removed endoscopically, along with a brief review of the literature.