Difficult diagnosis in atypical presentations of fish bone ingestion: two case reports and literature review

Abstract

Background and Aims: Fishbone ingestion (FBI) is relatively common in our locality as the fishes are usually not filleted during the preparation. The diagnosis of complication from FBI poses a particular challenge because it could mimic varieties of uncommon pathologies on computer tomography (CT). Methods: We will report the difficult diagnosis in two patients with atypical presentations after unintended FBI. Results: The first patient was a 45-year-old man presenting with right lower quadrant abdominal pain. CT showed a 2 cm abdominal wall abscess next to a segment of inflamed ileum. Meckel’s diverticulitis with concealed perforation was suspected and managed with antibiotics. Two months later, local resection was performed for an abdominal wall mass and then a 4 cm long fish bone was found inside the specimen. Another 69-year-old woman presented with one-month history of right lower quadrant abdominal pain. CT showed an infarcted omentum with a central linear hyperdensity, suspected to be thrombosed vessel. As the patient had high fever and peritonitis, emergency laparotomy was performed. Intraoperatively, a 3 cm long fishbone was embedded between the fibrotic omentum and ileocecal region. The most interesting point is that the two patients could not recall any incidence of FBI. Conclusion: The diagnosis of complication from FBI remains a great challenge to clinicians. High index of suspicion is warranted even though there is no history of FBI. [https://onlinelibrary.wiley.com/doi/10.1111/jgh.14491]