Case report: Successful endoscopic treatment of a large bowel perforation caused by chicken bone ingestion

Abstract

Rationale:Large bowel perforations by a foreign body are rarely diagnosed pre-operatively due to non-specific clinical symptoms. The safety and efficacy of foreign body removal via upper endoscopy is well-established and strongly recommended. There is far less experience of endoscopic treatment of sharp foreign bodies impacted in lower parts of gastrointestinal tract.Patient concerns:The patient was 78-year-old female with abdominal pain and nausea. Symptoms had begun 48hours prior to hospital admission. She had lost over 10kg of body weight in the previous couple of monthsDiagnosis:A multidetector-row computed tomography (MDCT) examination of the abdomen revealed mural thickening and enhancement of the cecum with haziness and linear areas of high attenuation in the pericecal fat tissue. A colonoscopy showed, the clear presence of a sharp 5.5-cm-long chicken bone perforating the cecal wall at the antemesenteric site close to the Bauchini valve.Interventions:A quarter of the bone that had penetrated the cecal wall was pulled out with a flexible colonoscopy using a polypectomy snare. Due to the form and length of the bone, it was withdrawn through the entire colon, using pointed end trailing.Outcomes:The patient was discharged three days after colonoscopy with normal laboratory results and without any pain.Lessons:In cases where sharp foreign bodies stuck into the large bowel, it is highly advisable to try to remove them via colonoscopy, before deciding to resolve the issue through a surgical intervention.