Fishbone-Induced Gastrointestinal Perforation: A 21-Case Series from Vietnam.
Phu Van La, Quan Hong Dang, Vu Anh Doan et al.
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Case in brief
This retrospective series included 21 patients treated for fishbone-induced gastrointestinal perforation at a tertiary hospital in southern Vietnam. Symptoms were often nonspecific, and patients may not recall swallowing a bone. CT was performed in 12 patients and showed a fishbone in 10 (83.3%). Laparoscopy was attempted in 17, identifying the perforation in each; 8 procedures were completed laparoscopically and 9 converted to open surgery. The colon was the most frequent perforation site. Postoperative complications occurred in 5 patients (23.8%), and one patient (4.8%) died.
What made this case unusual
Despite the often-unrecognized ingestion and nonspecific presentation, CT identified a fishbone in 10 of 12 imaged patients, and laparoscopy located the perforation in all 17 patients in whom it was attempted.
Diagnostic / clinical pearl
Consider fishbone perforation in unexplained peritonitis, particularly in regions with high fish consumption; CT and diagnostic laparoscopy can help identify the bone and perforation site.