A Case of Periproctal Abscess due to an Ingested Fish Bone Diagnosed by Ultrasonography

Significance of Preoperative Diagnosis and a Review of Previously Reported Cases in Japan

Abstract

A 65-year-old male came to our hospital with a chief complaint of anal pain. Digital examination revealed a painful induration around the anus. Because he was a heavy drinker, liked fish, had full dentures, and had histories of a gastrectomy and a hemorrhoid operation, periproctal abscess due to a penetrated fish bone through the anus was suspected. Ultrasonography showed a hypoechoic mass around the anus, and a hyperechoic thin foreign body in it. He was diagnosed as having a periproctal abscess due to a penetrated fish bone, and excisional drainage and removal of the fish bone were performed, which went well.
We found 13 case reports in the Japanese literature that described fish bone penetration or perforation of the rectum or anus. Almost all the cases had an abscess around the rectum or anus, but there were no cases of periproctal abscess due to penetrated fish bones that were diagnosed preoperatively by ultra-sonography and/or X-ray examination in these cases.
A case of periproctal abscess due to a penetrated fish bone is relatively rare, but it should be kept in mind when a patient has great potential for perforation or penetration of the digestive tract by a ingested fish bone.