A Case of Sigmoid Colon Perforation Caused by A Foreign Body That was Successfully Managed by Endoscopic Removal and Conservative Treatment

Abstract

Gastrointestinal perforation caused by a foreign body is relatively uncommon. We present a case of sigmoid colon perforation caused by a sharp foreign body that was successfully managed by endoscopic removal and conservative treatment. The patient was a 70-year-old woman who was referred to our hospital with lower abdominal discomfort and elevated inflammatory markers. Abdominal computed tomography (CT) revealed a linear high-density structure protruding outside the sigmoid colon and a localized abscess containing air, suggesting sigmoid colon perforation caused by a suspected fish bone. Given her mild symptoms, we selected conservative treatment. On the ninth day of hospitalization, colonoscopy showed a sharp foreign body penetrating the sigmoid colon mucosa, which was removed using forceps. Postoperative CT revealed no free air and the patient reported no worsening of the abdominal pain; therefore, the “nil by mouth” instruction and antibiotic therapy were continued. The patient showed a favorable clinical course; she resumed oral intake on postoperative day 5 and was discharged on day 8. Although colonic perforation caused by a foreign body is uncommon, in patients in stable general condition, endoscopic removal combined with conservative treatment can obviate the need for surgery, even in cases with relatively large abscesses or severe inflammatory response.