2007 Volume 27 Issue 7 Pages 1005-1008
A 71-year-old man was admitted to our hospital because of a sudden onset of medial lower abdominal pain. He had not previously undergone open laparotomy. Tenderness and muscular defense were noted in the medial lower abdomen, together with the pain. Elevated levels of both white blood cells and C-reactive protein were noted. Based on computed tomography (CT) imaging, a strangulated ileus was suspected and emergency surgery was performed. A laparotomy revealed dirty ascites in the peritoneal cavity and perforation of Meckel's diverticulum by a fish bone 30 cm orally from the end of the ileum. We performed a resection of the diverticulum with an autosuture system. When we asked the patient about what he had eaten, he responded that he had eaten a sea bream (porgy) the day before, although he was not aware of having swallowed a bone. The 2.2 cm long fish bone was recognized as a sharp bone from a sea bream. There was no abnormal mucosa around the perforated portion of the small intestine. Fifteen cases of perforation of Meckel's diverticulum by a fish bone have been reported in the Japanese literature. We experienced this further rare case, and report on it with a review of the literature.
