A Case of Perforation of Duodenum caused by a Fish Bone

The Review of the Japanese Literature

Abstract

A 62-year-old man hospitalized for abdominal pain was found to have localized peritonitis through diagnosed tenderness, muscular defense, and blood tests. Computed tomography (CT) showed small high-density spots in the duodenum and turbid adipose tissue around the superior mesenteric artery, but not revealed the cause of localized peritonitis. After admission for closer diagnosis, multislice CT showed a 3-cm linear shadow horizontally perforating the duodenum. Based on a preoperative diagnosis of duodenal perforation due to a fishbone, we conducted emergency surgery, finding that a fishbone had penetrated through the horizontal part of the duodenum to the mesentery. The jejunum around the perforation site was reddened and swollen. We removed the fishbone and sutured the perforation. We review 20 cases of duodenal perforation or fishbone penetration reported in the Japanese literature since 1983. Cases preoperatively diagnosed correctly have increased since 2000. Gastrointestinal endoscopy and CT have contributed to accurate diagnosis. Because extraction of fishbones by gastrointestinal endoscopy is required in duodenal perforation or penetration, it is important to diagnose acute abdomen correctly.