Two Cases of Chronic Gastrointestinal Perforation Caused by Ingested Fish Bones

Abstract

Gastrointestinal perforation caused by an ingested fish bone is relatively well-documented; however, we encountered two rare cases with an unusually prolonged clinical course. The first patient was a man in his 70s in whom abdominal CT performed for persistent pain revealed gastrointestinal penetration by a fish bone. As his symptoms and inflammatory findings subsided, at first, we only kept him under observation and managed him conservatively. Two years later, however, he presented to us with recurrent abdominal pain, and imaging examination revealed an intra-abdominal abscess. We performed laparoscopic surgery to drain the abscess and retrieved the fish bone. The second patient was an octogenarian woman who presented to us with abdominal pain that developed following a bicycle fall. Abdominal CT revealed omental inflammation with a central hyperdense linear structure, based on which we made the diagnosis of intra-abdominal abscess caused by a fish bone. We resected the inflamed omentum and embedded fish bone by laparoscopic surgery. In both patients, the postoperative course was uneventful, with no recurrence of the abscess. Patients with cognitive impairment or dementia could be oblivious to having ingested a fish bone resulting in a discrepancy between the history and clinical findings. CT findings are often characteristic; thus, clinicians should consider this diagnosis even in the absence of overt symptoms when such imaging features are observed.