Contained transverse colonic perforation caused by an ingested fish bone presenting as chronic abdominal pain: a case...

Foreign body ingestion is common; however, gastrointestinal perforation is rare and often poses a diagnostic challenge, particularly when symptoms are chronic and nonspecific. Colonic perforation due to ingested foreign bodies is uncommon, with the transverse colon being an especially rare site due to its mobility and wide lumen.

We report the case of a 19-year-old male who presented with central abdominal pain and intermittent diarrhea for 1 month, followed by acute worsening of abdominal pain, fever, nausea, and vomiting over the proceeding 3 days. Clinical examination revealed features of peritonitis. Laboratory investigations demonstrated leukocytosis and markedly elevated inflammatory markers. Ultrasonography and contrast-enhanced computed tomography revealed a localized intra-abdominal abscess containing a linear hyperdense structure suggestive of a foreign body. Emergency exploratory laparotomy identified a large concealed abscess cavity containing a 3-cm fish bone, associated with a sealed perforation of the transverse colon. Segmental transverse colectomy with en bloc abscess excision and side-to-side stapled anastomosis was performed. The patient recovered uneventfully and was discharged on postoperative day 5.

Foreign body-induced colonic perforation may present insidiously due to localized containment of contamination, resulting in delayed diagnosis. The absence of pneumoperitoneum and lack of a clear ingestion history further contribute to diagnostic difficulty. Cross-sectional imaging plays a crucial role, and timely surgical intervention is essential to prevent morbidity.

Ingested foreign bodies should be considered in young patients presenting with chronic abdominal pain and localized intra-abdominal abscesses, even in the absence of a clear history of ingestion, as delayed recognition may result in concealed gastrointestinal perforation.