Endoscopic management of gastric perforation secondary to chicken bone: A report of 2 cases

Ingested foreign bodies (IFB) can uncommonly cause perforation of the gastrointestinal tract. The traditional management is surgical exploration via laparotomy or laparoscopy, although endoscopic options are now gaining prominence.

We present two patients with almost identical clinical presentations of post-prandial abdominal pain and anorexia. On examination they were haemodynamically stable with localised epigastric tenderness. Both patients underwent CT scan of the abdomen, with one scan revealing a foreign body in the stomach penetrating the full thickness of the gastric wall with the tip lying extraluminally. They subsequently underwent endoscopy where a chicken bone was found perforating the wall of the stomach. This was removed via snare and endoscopic clips were used to close the site of perforation.

The majority of ingested foreign bodies pass through the gastrointestinal tract harmlessly. However some IFBs can cause significant complications like bowel obstruction, bleeding, abscess formation, migration to other organs, and in our case perforation. The diagnosis may be delayed due to an insidious clinical presentation especially if the patient does not recall ingesting anything untoward. Our patients managed to avoid surgery by undergoing successful endoscopic therapy.

In selected cases, endoscopic management is more cost-effective, minimally invasive, has less post-operative complications, and leads to a more expeditious recovery. Therefore, the role of therapeutic endoscopy for gastric perforations secondary to foreign bodies should always be considered.