Case Report
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World J Gastroenterol. Nov 7, 2012; 18(41): 5994-5998
Published online Nov 7, 2012. doi: 10.3748/wjg.v18.i41.5994
Medical treatment for a fish bone-induced ileal micro-perforation: A case report
Chein-Chung Kuo, Tsu-Kang Jen, Cheng-Hsin Wen, Chih-Ping Liu, Hai-Sung Hsiao, Yao-Chi Liu, Kuan-Ho Chen
Chein-Chung Kuo, Tsu-Kang Jen, Cheng-Hsin Wen, Department of Emergency Medicine, Kang-Ning General Hospital, Taipei City 114, Taiwan, China
Chih-Ping Liu, Department of Family Medicine, Kang-Ning General Hospital, Taipei City 114, Taiwan, China
Hai-Sung Hsiao, Department of Radiology, Kang-Ning General Hospital, Taipei City 114, Taiwan, China
Yao-Chi Liu, Kuan-Ho Chen, Department of General Surgery, Kang-Ning General Hospital, Taipei City 114, Taiwan, China
Author contributions: Kuo CC wrote the paper; Chen KH treated the patient; Jen TK, Wen CH, Liu CP, Hsiao HS, and Liu YC contributed to the discussion.
Correspondence to: Dr. Kuan-Ho Chen, Department of General Surgery, Kang-Ning General Hospital, No. 26, Lane 420, Section 5, Chenggong Road, Taipei City 114, Taiwan, China. kuanho0928@yahoo.com.tw
Telephone: +886-2-26345500 Fax: +886-2-26345393
Received: May 14, 2012
Revised: July 23, 2012
Accepted: July 28, 2012
Published online: November 7, 2012
Abstract

Ingested fish bone induced intestinal perforations are seldom diagnosed preoperatively due to incomplete patient history taking and difficulties in image evidence identification. Most literature suggests early surgical intervention to prevent sepsis and complications resulting from fish bone migrations. We report the case of a 44-year-old man suffered from acute abdomen induced by a fish bone micro-perforation. The diagnosis was supported by computed tomography (CT) imaging of fish bone lodged in distal ileum and a history of fish ingestion recalled by the patient. Medical treatment was elected to manage the patient’s condition instead of surgical intervention. The treatment resulted in a complete resolution of abdominal pain on hospital day number 4 without complication. Factors affecting clinical treatment decisions include the nature of micro-perforation, the patient’s good overall health condition, and the early diagnosis before sepsis signs develop. Micro-perforation means the puncture of intestine wall without CT evidence of free air, purulent peritoneum or abscess. We subsequently reviewed the literature to support our decision to pursue medical instead of surgical intervention.

Keywords: Fish bone ingestion; Micro-perforation; Decision-making; Medical treatment; Small intestine