Three Cases of Perforation or Penetration of the Colon by a Fish Bone

Abstract

Foreign bodies of the intestine are spontaneously excreted in most cases and rarely cause complications such as gastrointestinal perforation, in which the frequency is reported to be less than 1%. However, once intestinal perforation or penetration occurs, it can result in peritonitis or abdominal abscess formation. We studied three patients with lower intestinal perforation or penetration due to a fish bone who were treated in our hospital from January 2016 to September 2017. Their average age was 90.3 years, and the male-to-female ratio was 2 : 1. All lesions were in the sigmoid colon and presented as acute inflammatory findings. One patient presenting with generalized peritonitis underwent an emergency operation, while the remaining two underwent endoscopic removal with conservative therapy because the abdominal findings were localized. In the patient with generalized peritonitis, the laparotomy findings included only a small amount of contaminated ascites and a small size of the perforated site, so that only simple closure and irrigation drainage were performed. From these experiences, we can draw the following conclusions that intestinal perforation or penetration due to a fish bone should be kept in mind in the differential diagnosis for acute abdomen ; even if perforation or penetration by a fish bone is suspected, conservative treatment can be selected in some case, if abdominal findings are localized ; and there are some patients with generalized peritonitis who can be treated with less-invasive surgery, if his or her peritonitis is in an acute phase.