Small bowel perforation secondary to fish bone ingestion managed non-operatively

The presurgical diagnosis of foreign body (FB)-induced bowel perforation is exceedingly difficult. Perforation most commonly occurs in the ileocecal region and typically mimics diagnoses more common to the right lower quadrant (RLQ), including appendicitis and diverticulitis.

This report will discuss the events of this particular case of fish bone ingestion and subsequent small bowel perforation and the epidemiology, diagnosis, and management of FB ingestions.

This case describes a 28-year-old man who presents with a 4-h history of sharp, stabbing abdominal pain localized to the RLQ. Abdominal computed tomography revealed a 1.5-cm curvilinear foreign body traversing through a loop of small bowel in the RLQ. Upon further questioning, the patient recalled eating northern pike 2 days before. During his hospital stay, the patient noted improvement of his symptoms and thus was managed non-operatively without complication. The patient was discharged after complete resolution of his abdominal pain on hospital day number 2.

This represents a rare case of small bowel perforation secondary to fish bone ingestion that was managed non-operatively without complication.