A Case of Intraperitoneal Hemorrhage Caused by Fish Bone Perforation of the Small Bowel

Abstract

A 93-year-old man was referred to our hospital due to abdominal pain. Computed tomography showed diffuse hemorrhagic ascites and a radiopaque, linear object in the small bowel with a small amount of air in the mesentery. Laboratory findings showed an increased inflammatory response and severe anemia. Acute peritonitis caused by fish bone perforation was diagnosed. On emergency laparotomy, a large amount of hemorrhagic ascites and blood clots were seen. After intraperitoneal lavage, a bleeding point with fish bone exposed outside the small intestinal wall was seen. The small bowel with a fish bone about 10 cm in length was resected. The patient was discharged on day 36 after surgery, although he had severe anemia postoperatively due to anastomotic bleeding. Gastrointestinal perforations caused by fish bones are reported to account for less than 1% of perforations, and fish bone perforation with intraperitoneal massive hemorrhage is very rare. Therefore, this case is presented along with the relevant literature.