Computed tomography description of abdominal complications due to fishbone ingestion

Inadvertent ingestion of fishbone can lead to bowel perforation. Numerous cases reports have been published; therefore, we aimed to describe the localization and type of complication in a dedicated cohort.

From 2009 to 2023, we queried our local informatic department (Cayenne Hospital, French Guiana) to search electronic patient records (ICD-10 code T18: Foreign body in alimentary tract) and we reviewed each case to identify abdominal complication caused by fishbone ingestion. Patients with complication occurring above the stomach without a computed tomography available (CT) were excluded. Clinical, biological, imaging and treatment related data were collected. The overall raw incidence was estimated.

Forty-two patients (mean age: 60 years old ± 15; female 36%) were included for analysis from May 2014 to June 2023. Abdominal pain was present in 41/42 patients (98%) and inflammatory biological syndrome was found in 34/42 patients (81%). On CT, perforation of the bowel wall was seen in 41/42 patients (98%), intra-abdominal collection in 17/42 patients (40%) and pneumoperitoneum in 2/42 patients (5%). The ileum (11/42, 26%) was the most common complication site, followed by the liver (6/42, 14%), and the right colon and stomach (5/42, 11% each). Treatment included surgery for 23/42 patients (55%), antibiotics alone for 14/42 patients (33%), endoscopic removal for 4/42 patients (10%), and percutaneous drainage for 1/42 patient (2%). The estimated incidence was 2.9 per 100,000 person-years.

We report the largest analysis of bowel perforation secondary to fishbone ingestion, providing an exhaustive spectrum of localization and type.