title: Medical treatment for a fish bone-induced ileal micro-perforation: a case report.
abstract: Ingested fish bone induced intestinal perforations are seldom diagnosed preoperatively due to incomplete patient history taking and difficulties in image evidence identification. Most literature suggests early surgical intervention to prevent sepsis and complications resulting from fish bone migrations. We report the case of a 44-year-old man suffered from acute abdomen induced by a fish bone micro-perforation. The diagnosis was supported by computed tomography (CT) imaging of fish bone lodged in distal ileum and a history of fish ingestion recalled by the patient. Medical treatment was elected to manage the patient's condition instead of surgical intervention. The treatment resulted in a complete resolution of abdominal pain on hospital day number 4 without complication. Factors affecting clinical treatment decisions include the nature of micro-perforation, the patient's good overall health condition, and the early diagnosis before sepsis signs develop. Micro-perforation means the puncture of intestine wall without CT evidence of free air, purulent peritoneum or abscess. We subsequently reviewed the literature to support our decision to pursue medical instead of surgical intervention.
authors.affiliation: Department of Emergency Medicine, Kang-Ning General Hospital, Taipei City 114, Taiwan, China.
authors.forename: Chein-Chung
authors.initials: CC
authors.lastname: Kuo
authors.forename: Tsu-Kang
authors.initials: TK
authors.lastname: Jen
authors.forename: Cheng-Hsin
authors.initials: CH
authors.lastname: Wen
authors.forename: Chih-Ping
authors.initials: CP
authors.lastname: Liu
authors.forename: Hai-Sung
authors.initials: HS
authors.lastname: Hsiao
authors.forename: Yao-Chi
authors.initials: YC
authors.lastname: Liu
authors.forename: Kuan-Ho
authors.initials: KH
authors.lastname: Chen
mesh_terms: D000006:Abdomen, Acute / Q000209:etiology / Q000628:therapy; D000328:Adult; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001842:Bone and Bones; D003131:Combined Modality Therapy; D005399:Fishes; D005440:Fluid Therapy; D005547:Foreign Bodies / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007077:Ileal Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D007416:Intestinal Perforation / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D008297:Male; D017747:Seafood / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Decision-making; Fish bone ingestion; Medical treatment; Micro-perforation; Small intestine