Fishbone-Induced Gastrointestinal Perforation: A 21-Case Series from Vietnam

Gastrointestinal (GI) perforation caused by fishbone ingestion is rare but potentially life-threatening. Because symptoms are nonspecific and most patients do not recall or are unaware of ingesting the bone, diagnosis is often delayed. This study presents a series of 21 patients with fishbone-induced GI perforation and highlights the importance of early surgical intervention. We retrospectively reviewed 21 patients treated at a tertiary referral hospital in southern Vietnam, from June 2022 to August 2024. Data included demographics, symptoms, imaging findings, surgical approach, perforation site, complications, and outcomes. Thirteen patients were female (61.9%), and the mean age was 57.7±13.2 years (range, 39-85). Computed tomography (CT) was performed in 12 patients, and a fishbone was identified in 10 cases (83.3%). Diagnostic laparoscopy was attempted in 17 patients (81%), and the perforation site was identified in all attempted cases. Laparoscopic surgery was completed in 8 patients (47.1%), whereas 9 of 17 patients (52.9%) required conversion to open surgery. Four patients (19.0%) underwent primary open surgery. The most common perforation site was the colon (13 patients, 61.9%), followed by the small intestine (6 patients, 28.6%) and the stomach (2 patients, 9.5%). Postoperative complications occurred in 5 patients (23.8%), and one patient (4.8%) died. The mean postoperative hospital stay was 8.7±5.1 days (range, 3-26). Fishbone-induced GI perforation should be considered in patients with unexplained peritonitis, especially in regions with high fish consumption. CT and laparoscopy are key diagnostic tools. Early surgical intervention reduces morbidity and improves outcomes.