Small intestinal fish bone perforation

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. An 85-year-old woman with type 2 diabetes mellitus presented to the hospital with abdominal distention and pain in the left lower quadrant since the previous night. She had a history of surgery for transverse colon cancer and hospitalization for postoperative adhesive intestinal obstruction. Physical examination revealed a body temperature of 37.5°C and tenderness of the left lower quadrant of the abdomen (without rebound tenderness). Laboratory tests revealed the following: white blood cell count, 9.50×109/L (3.17–8.40×109/L); neutrophil count, 84.2%, and C-reactive protein level, 2.0 mg/L (reference <3.0 mg/L). Plain abdominal computed tomography (CT) revealed that the small intestine in the lower left abdomen was surrounded by fat stranding with intraperitoneal free air; a high-density body, indicating a fish bone (Fig. 1a, b), was found penetrating the wall.