A Case of Small Intestinal Perforation by a Fish Bone in an Incarcerated Inguinal Hernia

Abstract

A 75-year-old woman was admitted to our hospital because of abdominal pain and vomiting. Abdominal examination revealed localized tenderness and a mass that seemed like the intestine in the lower left quadrant. An abdominal computed tomography scan showed part of the small intestine with a linear, high-density lesion in the inguinal region and distension of the oral side of the small intestine. She was diagnosed with incarcerated inguinal hernia, and an emergency operation via the open anterior approach was performed. During the surgical procedure, a hernia sac containing an incarcerated small intestine was observed. Opening of the hernia sac revealed a perforation in the small intestine caused by a fish bone. The perforated bowel was resected, and inguinal hernia repair was performed using the McVay operation. The postoperative course was uneventful, and she was discharged 15 days after the operation. In this case, when the fish bone reached the prolapsed small intestine in the inguinal hernia sac, it could not pass through because the degree of the freedom of mobility of the small intestine was restricted. In addition, the intestinal wall was inflamed and thickened due to the perforation. It was considered that the intestinal wall could not return to the abdominal cavity and became incarcerated.