title: Jejunal perforation due to ingested buffalo bone mimicking acute appendicitis.
abstract: BACKGROUND
  Foreign body ingestion is seen quite frequently in clinical practice, intestinal perforation due to this is rare. The foreign body often mimics another cause of acute abdomen and requires an emergency surgical intervention. The majority of patients do not recall ingesting sharp foreign bodies.
  
  
  METHODS
  We report an interesting case of a fifty five year-old man who presented with pain in the right iliac fossa with localised tenderness which was clinically diagnosed as acute appendicitis. During the operation, the presence of purulent collection and the inflamed bowel with flakes raised suspicion of bowel perforation. The assessment of the proximal small bowel revealed two small perforations in the jejunum. A hard, bony and sharp object was extracted and the perforations were closed. Post-operative recovery was uneventful. Detailed food history was taken following the recovery of the patient from surgery. It revealed the history ingestion of home prepared buffalo meat. The extracted object was identified as 'buffalo bone' by the patient and the care taker of the patient. The jejunum was perforated by the ingested buffalo bone causing local peritonitis in right iliac fossa.
  
  
  CONCLUSIONS
  Intestinal perforation by ingested foreign bodies should be suspected in acute abdomen. It requires a high degree of suspicion and awareness on the part of the clinician.
authors.affiliation: Department of General Practice and Emergency Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal. ajay.yadav@bpkihs.edu.
authors.forename: Ajay Kumar
authors.initials: AK
authors.lastname: Yadav
authors.affiliation: Department of General Practice and Emergency Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: Gyanendra
authors.initials: G
authors.lastname: Malla
authors.affiliation: Department of General Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: Kunal Bikram
authors.initials: KB
authors.lastname: Deo
authors.affiliation: Department of General Practice and Emergency Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: Saroj
authors.initials: S
authors.lastname: Giri
authors.affiliation: Department of General Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: Bishnu Murti
authors.initials: BM
authors.lastname: Bhattarai
authors.affiliation: Department of General Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: Shailesh
authors.initials: S
authors.lastname: Adhikary
mesh_terms: D000208:Acute Disease; D000818:Animals; D001064:Appendicitis / Q000175:diagnosis* / Q000209:etiology; D001842:Bone and Bones; D002020:Buffaloes; D003937:Diagnosis, Differential; D004435:Eating; D005547:Foreign Bodies / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D007416:Intestinal Perforation / Q000175:diagnosis* / Q000209:etiology*; D007583:Jejunum / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000175:diagnosis / Q000209:etiology; D012421:Rupture / Q000209:etiology
keywords: Buffalo bone; Case report; Foreign body; Jejunum perforation; Local peritonitis