Objectives

• To review spectrum of abdominal complication associated with fishbone perforation utilizing abdomen CT scan.

• To discuss management and treatment options.

Background

•Fishbone is the most common accidentally ingested gastrointestinal foreign body.

•It can cause diagnostic challenges both clinically and radiologically as most patients don’t recall ingestion of the fishbone.

•In few cases, it can be seen as incidental findings on CT done for other reason.

•It can be mistaken for other inflammatory conditions or neoplastic process causing a diagnostic dilemma and unnecessaryinvestigations.

•The most common sites of perforation in :

Esophagus : cricopharyngeus muscle (C5/C6 )

Stomach : lesser curvature

Small bowel : ileum

Large bowel: rectosigmoid junction

Imaging findings OR Procedure findings

case 1

•54 y/o female presented with nonspecific abdominal pain.

•CT show 3.5 cm linear hyperdense fishbone penetrated the gastric pylorus into the hepatic fissure.

•Thrombophlebitis of the intrahepatic portal veins. No abscess or pneumoperitoneum.

Conclusion

•In most cases, the fishbone can pass through the gastrointestinal tract uneventfully.

•Perforated fishbone can be a diagnostic challenge.

•The use of CT is very helpful in elicit the cause of the patient pain, site of the fishbone perforation and associated complications.

•Radiologist need high index of suspicion especially in a high-risk patient with unexplained inflammatory abdominal changes.