2016 Volume 36 Issue 4 Pages 753-756
A 79-year-old female was admitted with a history of acute-onset epigastralgia that began 2 days after she ate salmon. The serum CRP and peripheral-blood white blood cell count were markedly elevated. An MDCT scan revealed a linear high-density object causing perforation of the distal part of the duodenum. Laparotomy was performed, which revealed an edematous duodenal wall adjacent to the ligament of Treitz. Dissection of the oral portion of duodenum was performed；a fish bone, 3cm in length, was found protruding from the duodenal wall, which was readily removed, and the perforated duodenal wall sutured. The postoperative course was uneventful. The patient was discharged 10 days after the surgery. Perforation of the duodenum adjacent to the ligament of Treitz caused by an ingested fish bone is a rare occurrence. Urgent MDCT was helpful in the diagnosis and in the decision to perform emergency laparotomy. We believe that prompt surgical removal of the fish bone is necessary in such cases of duodenal perforation, before further complications such as punctures of the liver and/or pancreas develop.
