A Case of Peritonitis Caused by an Ingested Fish Bone following Gastrectomy Successfully Treated with Endoscopic Treatment : Analysis of 17 Cases of Perforation or Penetration of Digestive Organs due to a Fish Bone Reported in the Japanese Literature

Abstract

A 74-year-old man, who had previously undergone gastrectomy, was admitted to the hospital because of upper abdominal pain and reddish surgical scar. There were tenderness and rebound tenderness in the upper abdomen and he was diagnosed with localized peritonitis. An abdominal X ray film showed no demonstrable free air, whereas an abdominal CT scan showed an about 2-cm long liner high density foreign object, and high fat density around the proximal jejunum just under the abdominal wall. It was revealed to be a black rockfish's bone based on a patient interview. Localized peritonitis with penetration of the jejunum caused by the ingested fish bone was diagnosed, and upper gastrointestinal endoscopic examination was performed. The fish bone was found at around 15-cm anal side from the Roux-en-Y limb, and removed endoscopically. A bibliographic review was undertaken searching 16 post-gastectomy cases of penetration of digestive tract by a fish bone reported in the Japanese literature between 1983 and 2013. All patients except this patient were treated surgically. We present an interesting case of the patient who could be diagnosed as fish bone ingestion and conservatively treated by successful endoscopic removal of the fish bone.