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Marine predator strikes rectally inserted eel fish causing colonic perforation: a rare case report and review of
Akash Saha1, Mohammad Mashiur Rahman2, Abidur Rahman1
1Department of Surgery, Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh.
Introduction And Importance:
Gastrointestinal perforation is a very common surgical emergency with significant mortality and morbidity, which needs urgent intervention. Foreign body-related perforations are very rare, accounting for less than 1% of cases. However, Colonic perforation by Eel fish is an extremely rare phenomenon; only three cases have been reported in the existing literature. Here, we report a rare case of traumatic colonic perforation with septic shock by a rectally inserted Eel fish.
Case Presentation:
A 25-year-old male presented to the emergency department with a 4-day history of abdominal pain, accompanied by high-grade fever and a loss of consciousness lasting 1 day. Initial workups suggested the case might be a case of intestinal perforation with septic shock. However, in the abdominal X-ray, there was a bizarre radiopaque shadow in the right iliac fossa. Emergency exploratory laparotomy was done, and a large perforation was found at the rectosigmoid junction. Multiple pieces of fish bone were found in the peritoneal cavity. A putrefied Eel fish was found in the peritoneal cavity, approximately 25 cm in length.
Clinical Discussion:
After thorough peritoneal toileting, a Hartmann-like procedure, where the distal end was closed and secured with a silk suture and the proximal exteriorized for fecal diversion, was done, and the patient was shifted to the intensive care unit. However, despite the best medical care, the patient expired on the third postoperative day.
Conclusion:
Live animals causing rectal perforation have rarely been documented in the literature. Unusual healthcare beliefs, inadvertent sexual conduct, or criminal aggressiveness may be involved. However, the cause may remain a mystery. Rapid diagnosis with proper history, aided by imaging, with urgent surgical intervention, may increase patient survival. Therefore, emergency care physicians should also be conscious of the rare and unusual causes of intestinal perforation to reach the diagnosis promptly.
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