Ileal perforation from accidental lamb mandibular bone fragment ingestion: a rare but serious diagnostic challenge

Small bowel perforation due to accidental foreign body ingestion is a rare but serious condition that often presents with nonspecific symptoms, posing a diagnostic challenge. Early recognition is critical to avoid life-threatening complications.

A 65-year-old male presented with acute abdominal pain and localized tenderness without a clear etiology. Laboratory investigations revealed elevated inflammatory markers levels. An abdominal CT scan revealed a 4 cm linear, hyperdense object lodged in the ileum, suggestive of a bone fragment. Despite the absence of contrast extravasation on follow-up imaging, exacerbation of symptoms and clinical deterioration warranted urgent surgical intervention. Diagnostic laparoscopy revealed a perforated ileum with a sharp lamb mandibular bone fragment penetrating both sides of the bowel wall. The foreign body was successfully extracted, and the bowel was repaired laparoscopically. Postoperative recovery was uneventful, and the patient was discharged on postoperative day three.

This case underscores the importance of maintaining a high index of suspicion for foreign body ingestion in patients presenting with acute abdomen, even in the absence of a reported ingestion history. While imaging remains the cornerstone for diagnosis, surgical exploration is warranted in equivocal or worsening cases. Laparoscopy offers a safe and effective minimally invasive solution.

Foreign body-induced small bowel perforation should be included in the differential diagnosis of unexplained acute abdominal pain. Early imaging and timely surgical management are essential to prevent serious complications.