The Teaching Point

Although ingested foreign bodies typically pass through the digestive tract without incidence, physicians should be aware that in rare cases appendicitis may result from perforation caused by foreign bodies (such as fishbone) and hence, good clinical history together with active search for foreign bodies on imaging should clinch the diagnosis. Radiological finding of a fishbone behooves the surgeon to look for and remove the fishbone, which could otherwise become a nidus for intra-abdominal infection, as well as prompts the surgeon to actively look for and manage possible associated complications such as bowel fistulation or perforation in other segments, in addition to performing the appendectomy.






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From the manuscript

Fishbone Perforated Appendicitis

Free full text article: Fishbone Perforated Appendicitis

Abstract
Ingested foreign bodies tend to pass through the gastrointestinal tract without incidence, and vast majority of cases do not need intervention. Rarely, these foreign bodies drop into the appendix and not likely to re-enter the normal digestive tract. We describe a case of a 72-year-old male patient who presented with right iliac fossa pain of 3-day duration. Clinical examination suggested classic acute appendicitis. Blood test results revealed leukocytosis. Computed tomography of the abdomen and pelvis showed evidence of acute appendicitis and a linear hyperdensity (foreign body) perforating the appendix. The patient was managed successfully with prompt laparoscopic appendectomy and removal of the foreign body which was confirmed to be a fish bone measuring about 10mm. While imaging diagnosis of fishbone in the appendix has been published, reports are few. To the best of the author`s knowledge, fishbone induced perforated appendicitis has been described only in 2 cases (including this case) in the literature.






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