Hospital: Hospital Clínico Universitario Virgen de la Arrixaca.
Aut@r o Autores: D. Gea Martos, M. Ato González, E. López Banez, M. Martínez Cutillas, I. Sánchez Serrano, G. De Paco Tudela.
Female of 83 years old came to the emergency department complaining of abdominal pa in and fever. Because of the clinical suspicion of acute abdomen, an abdominal ultrasou nd was performed, without evidence of pathological findings. The study was completed with a computed tomography (CT), showing: Lineal 3cm long high density in the upper portion of the pyloric antrum, with intrahepatic extension (IVb segment). Parietal inflam matory changes in the antrum with a small collection between it and the hepatic parench yma and contained microperforation. Hypodense area in the liver parenchyma adjacent t o the foreig body, that could correspond with edematous/inflammatory changes, without evidence of intrahepatic collections. The gastroscopy was normal. Finally the surgery c onfirmed the diagnosis and a fishbone was extracted.
The diagnosis of this patient was gastrointestinal perforation by a fishbone. It is a rare c omplication of ingested foreign bodies, as most of them move trough the gastrointestina l tract and are defecated. Fish bones are the most common cause of perforation and it ca n occur in any part of the gastrointestinal tract, although with predilection for curvatures : terminal ileum, rectosigmoid and minor curvature or pyloric antrum, as it case. Accidental ingestion of f ish bones may pass unnoticed for the patient and can cause symptoms for months or yea rs afte the intake. Computed tomography is more sensitive than plain films and ultrasou nd, but the use of contrast makes it difficult and the findings can be very subtle. Fish bo nes are shown like linear calcium density and findings like parietal thickening and penu moperitoneum can also help locating the perforation site.
Gastrointestinal perforation is a rare complication of ingested fish bones. Computed tom ograpphy is the modality of choice. It can be a diagnostic challenge as usually is not clin ically suspected and imaging findings can be subtle, so it requires a detailed evaluation by the radiologyst.
- Goh BK, Tan YM, Lin SE et-al. CT in the preoperative diagnosis of fish bone perforation of the gastrointestinal tract . AJR Am J Roentgenol. 2006,187 (3): 710-4. - Choi Y, Kim G, Shim C, Kim D, Kim D. Peritonitis with small bowel perforation caused by a