Conservative Treatment for Penetration of the Small Intestine Caused by a Fish Bone: A Case Report

Abstract

A 41-year-old woman presented to our hospital with a two-day history of abdominal pain. Abdominal CT revealed a fish bone penetrating the small intestine. Although we recommended surgical treatment, the patient refused surgery, and we adopted a conservative treatment approach. Single-balloon enteroscopy was performed in an attempt to retrieve the fish bone, but the foreign body could not be detected. Follow-up CT performed the following day revealed migration of the fish bone to the extraintestinal space, with no other abnormal findings. At the patient’s request, we continued conservative treatment and with gradual improvement of the symptoms, the patient was discharged on day 8 after admission. Yet another CT performed 1 month later still revealed the intraperitoneally migrated fish bone, but there were no other abnormal findings, and careful follow-up was continued. At 3 months, the fish bone remained in place. The patient continued to refuse surgical intervention and also declined further follow-up. Review of the literature published to date reveals that in cases of intestinal penetration or perforation by a fish bone, surgical removal remains the recommended standard of care. However, in patients who refuse surgery, as in our case, or patients in whom surgery is not feasible, conservative treatment may be an acceptable approach. Nevertheless, it is essential to thoroughly explain the potential risks, such as of recurrence of inflammation, and to ensure strict clinical monitoring.