• Dr. Shariful Islam Department of General Surgery, San Fernando Teaching Hospital, TRINIDAD AND TOBAGO
  • Anthony Maughn Department of General Surgery, San Fernando Teaching Hospital, TRINIDAD AND TOBAGO
  • Patrick Harnarayn Department of Clinical Surgical Sciences, University of the West Indies, St Augustine, TRINIDAD AND TOBAGO
  • Professor Vijay Naraynsingh Department of Clinical Surgical Sciences, University of the West Indies, St Augustine, TRINIDAD AND TOBAGO



Small Bowel Perforation, Fish Bone Or Foreign Body Perforation Of Small Bowel

Abstract [English]

Accidental ingestion of foreign bodies is a commonly encountered event in clinical practice. However, small bowel perforation due to a fish bone is a rare phenomenon. Often, the exact diagnosis is missed preoperatively and is revealed only at laparotomy. Delay in diagnosis and treatment can be associated with significant morbidity and mortality. We report a case of 54- year male who presented with right lower quadrant pain with nausea and vomiting. Clinically, Acute appendicitis was diagnosed. Computerized tomography (CT) of the abdomen confirmed pockets of free air in the right lower quadrant with fat streaking suggestive of perforated ileum. On exploratory laparotomy, the ileal perforation was confirmed secondary to a fish bone. Although rare, foreign body perforation of the small bowel should be entertained in the differential diagnosis in certain groups of patients presenting with acute abdomen.


Download data is not yet available.


E. Mc Canse, A. Kurchin, S.R. Hinshaw Gastrointestinal foreign bodies Am J Surg, 142 (1981), pp. 335–337

M.A. Pinero, J.A. Fernandez, P.M. Carrasco, R.J. Riguelme, P.P. Parrilla, Intestinal perforation by foreign bodies Eur J Surg, 166 (2000), pp. 307–309

Ayantunde AA and Oke T (2006), A review of gastrointestinal foreign goodies; International Journal of Clinical Practice 60(6) 735–9 DOI:

Nagaraj HS and Sunil I (2005). Multiple foreign body ingestion and ileal perforation, Paediatric Surgery International 21(9) 718–20 DOI:

Jo Nandi P and Ong GB (1978). Foreign body in oesophagus: review of 2394 cases. British Journal of Surgery 65 5–9 DOI:

Goh BK, Chow PK, Quah HM, Ong HS, Eu KW, Ooi LL and Wong WK (2006). Perforation of gastro-intestinal tract secondary to ingestion of foreign bodies, World Journal of Surgery 30(3) 372–7 DOI:

B. Coulier, M.H. Tancredi, A. Ramboux Spiral CT and multi-detector-row CT diagnosis of perforation of the small intestine caused by ingested foreign bodies EurRadiol, 14 (2004), pp. 1918–1925

Velitchkov NG, Grigorov GI, Losanoff JE and Kjossev KT (1996); Ingested foreign bodies of the gastrointestinal tract: retrospective analysis of 542 cases. World Journal of Surgery 20(8) 1001–5 DOI:

Alex M Almoudarisa, Andre Chowa, SashinKaneriaa, Zainab Jiyada, Dimitri J Hadjiminas, Fish Bone Perforation Mimicking Acute Appendicitis, Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online

Sheng-Der Hsu, De-Chuan Chan, Yao-Chi Liu, Small-bowel perforation caused by fish bone World J Gastroenterol 2005;11(12):1884-1885, ISSN 1007-9327 DOI:

HuseyinPulata, OktayKarakosea, Mehmet FatihBenzinb, SeymaBenzinc, RecepCetina, Small bowel perforation due to fish bone: A case report, Turkish Journal of Emergency Medicine, Volume 15, Issue 3, September 2015, Pages 136–138, doi:10.1016/j.tjem.2015.11.008 DOI:

Khan AS and Ali U (2006). Ingestion of metallic rods and needles; Journal of the College of Physicians and Surgeons Pakistan 16(4) 305–6

Sandeep Joglekar, Iqbal Rajput, SachinKamat and Sarah Downey, Sigmoid perforation caused by an ingested chicken bone presenting as right iliac fossa pain mimicking appendicitis: a case report Journal of Medical Case Reports20093:7385 DOI: 10.4076/1752-1947-3-738

A Patloo, M Zaz, A Amin, R Bali, M Khan, M Khan. Small-Bowel Perforation Caused By A Swallowed Chicken Bone – A Case Report. The Internet Journal of Surgery, 2012 Volume 28 Number 4 DOI:

Kimbrell FT Jr, Tepas JJ and Mullen JT (1975); Chicken bone perforation of the sigmoid colon: a report of three cases. The American Surgeon 41(12) 814-7

M. Hashmonai, T. Kaufman, A. Schramer Silent perforations of the stomach and duodenum by needles Arch Surg, 113 (1978), pp. 1406–1409

Cossavella D, Clerico G, Paino O and Pozzo M (1998); Trompetto M. Intestinal perforation caused by tooth picks; Minerva Chirurgica 53(3) 219–22

Oscar D. Almeida, John M. Val-Gallas, MD2, Small Trocar Perforation of the Small Bowel: A Case Report JSLS. 1998 Jul-Sep; 2(3): 289–290.PMCID: PMC3015313

Cleator IG and Christie J (1973); An unusual case of swallowed dental plate and perforation of the sigmoid colon. British Journal of Surgery 60(2) 163-5 DOI:

M. Maleki, W.E. Evans; Foreign body perforation of the intestinal tract; report of 12 cases and review of the literature Arch Surg, 101 (1970), pp. 474–477

Peter Webster, A Peckham-Cooper, Mark Lansdown, Small bowel perforation secondary to accidental dental plate ingestion International Journal of Surgery Case Report 2(7):218-20 DOI:

Arshad M. Malik, Small bowel perforations due to deliberate ingestion of injurious foreign bodies- a personal experience, J Ayub Med Coll Abbottabad 2008;20 (2)

R. AlagarSamy and R. Purushothaman, A rare case of a small bowel perforations with multiple foreign bodies due to deliberate ingestion of injurious foreign bodies, Indian Journal of Medical Case Reports 2014 Vol. 3 (4) October-December, pp. 90-94 ISSN: 2319–3832(Online)

Y. Yagmur, H. Ozturk Distal ileal perforation secondary to ingested foreign bodies J Coll Physicians Surg Pak, 19 (2009), pp. 452–453

S. Akbulut, B. Cakabay, C.A. Ozmen, A. Sezgin, M.M. Sevinc, An unusual cause of ileal perforation: report of a case and literature review World J Gastroenterol, 15 (2009), pp. 2672–2674

Dhavan A Parikh, Janak A Parikh, Gregory C Albers and Charles F Chandler, Acute small bowel perforation after wireless capsule endoscopy in a patient with Crohn’s disease: a case report, Cases Journal 2009, 2:7607 doi: 10.4076/1757-1626-2-7607 DOI:

TahsinColak, TolgaOlmez, OzgurTurkmenoglu, and Ahmet Dag, Small Bowel Perforation due to Gossypiboma Caused Acute Abdomen, Case Rep Surg. 2013; 2013: 219354. doi: 10.1155/2013/219354, PMCID: PMC3830857 DOI:

Jin-Jian Xiang, Ben-Jing Cheng, Fu Tian, Mi Li, Xue-Feng Jiang, Hui-Chuan Zhao, Xiao-Miao Hu, Bao-Lai Xiao, Jian-Ping Xie, and Arpana Shrestha, Perforation of small bowel caused by Schistosoma japonicum: A case report World J Gastroenterol. 2015 Mar 7; 21(9): 2862–2864.doi: 10.3748/wjg.v21.i9.2862, PMCID: PMC4351245 DOI:

J.I. Rodríguez-Hermosa, N. Canete, E. Artigau, J. Girones, P. Planellas, A. Codina-Cazador, Small bowel perforation by an unusual foreign body Rev EspEnferm Dig, 101 (2009), pp. 639–641

K.M. Chu, H.K. Choi, H.H. Tuen, S.Y. Law, F.J. Branicki, J. Wong A prospective randomized trial comparing the use of the flexible gastroscope versus the bronchoscope in the management of foreign body ingestion GastrointestEndosc, 47 (1998), pp. 23–27

B. Coulier Diagnostic ultrasonography of perforating foreign bodies of the digestive tract J BelgeRadiol, 80 (1997), pp. 1–5

32.B.K. Goh, Y.M. Tan, S.E. Lin, et al. CT in the preoperative diagnosis of fish bone perforation of the gastrointestinal tract AJR Am J Roentgenol, 187 (2006), pp. 710–714

Malcolm Fidler, Foreign-body perforation of jejunal diverticulum British Journal of Surgery 59(9):744-5 .August1972 DOI: 10.1002/bjs.1800590918 DOI:

Ali W and Khan M (2007), Intestinal perforation due to an ingested foreign body; Journal of the College of Physicians and Surgeons Pakistan 17(4) 234

Eldridge WW Jr (1961). Foreign bodies in the gastrointestinal tract; JAMA 178 665–7 DOI:

Karamarkovic AR, Djuranovic SP, Popovic NP, Bumbasirevic VD, Sijaki AD, Ivan V. Hepatic abscess secondary to a rosemary twig migrating from stomach into liver. World j Gastroenterol. 2007; 13(4):5530–32 DOI:

M. Takada, R. Kashiwagi, M. Sakane, F. Tabata, Y. Kuroda 3D-CT diagnosis for ingested foreign bodies Am J Emerg Med, 18 (2000), pp. 192–193

L. Ginzburg, A.J. Beller The clinical manifestations of non-metallic perforating intestinal foreign bodies Ann Surg, 86 (1927), pp. 918–939

P. Taourel, N. Kessler, A. Lesnik, P.M. Blayac, L. Morcos, J. M. Bruel, Non-Traumatic abdominal emergencies: imaging of acute intestinal obstruction, EurRadiol, 12 (2002), pp. 2151–2160

American society for gastrointestinal Endoscopy (2002), Guidelines for ingested foreign bodies; Gastrointestinal Endoscopy 55 802–6 DOI:




How to Cite

Islam, S., Maughn, A., Harnarayn, P., & Naraynsingh, V. (2016). FISH BONE PERFORATION OF SMALL BOWEL MIMICKING ACUTE APPENDICITIS. International Journal of Research -GRANTHAALAYAH, 4(7), 66–74.