Rare case of intestinal perforation due to fish bone: a report

Dr Takafumi Taguchi and Dr Hiroyuki Kitagawa at Kochi Medical School, Nankoku, Japan have reported a rare case of accidental ingestion of fishbone that led to perforation of the intestine. The case has appeared in the New England Journal of Medicine.

Accidental swallowing of fish bones is a common occurrence but it's rare for a swallowed "foreign body" to cause a tear in the intestine; less than 1% of cases of an ingested foreign body result in such a tear, according to a 2014 paper published in the World Journal of Gastroenterology. Even fish bones, with their sharp ends, pass through the gastrointestinal tract without causing problems, the authors of the 2014 paper said. People who wear dentures are at higher risk of ingesting fish bones because they may have trouble feeling the bones in their mouth while eating.

Courtesy NEJM

In the instant case, a 73-year-old man presented to the emergency department with the acute onset of severe lower abdominal pain. During a physical exam at the hospital, the man had tenderness across his lower abdomen, as well as a slight fever. The man told doctors that, the day before his pain started, he had eaten yellowtail fish. His temperature was 38°C, blood pressure 122/69 mm Hg, and heart rate 77 beats per minute. On physical examination, he had tenderness across the lower abdomen with rebound tenderness. Laboratory tests showed a white cell count of 10,300 per cubic millimetre (reference range, 3300 to 8600) with 83% neutrophils. Computed tomography of the abdomen revealed a thickened gut wall and penetration of the small intestine by a linear, high-density body (Panel A). Laparotomy revealed a small-bowel perforation from a fishbone 2 cm in length (Panel B). Small-bowel resection was performed, and the patient received treatment with antibiotic agents. The postoperative course was uncomplicated, and the patient was discharged home on day 8 after surgery.

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DOI: 10.1056/NEJMoa1807365