Fishbone impaction with cecal perforation mimicking acute appendicitis: A case report

• Published in: Journal of pediatric surgery case reports 2023-09, Vol.96, p.102700, Article 102700
• Main Authors: Lau, Sze-ting Christie, Ting, Louise Bik-yu, Fung, Adrian Chi-heng, Lau, Eugene Chin-tung, Wong, Kenneth Kak-yuen
• Format: Article
• Language: English
• Subjects: Case report; Children; Fishbone; Foreign body; Intestinal perforation
• ISSN: 2213-5766; 2213-5766
• DOI: 10.1016/j.epsc.2023.102700

Introduction: Right lower quadrant pain is a usual presentation of many acute abdominal conditions. However, it could as well be the presentation of unusual conditions. To date, cecal perforation as a result of fish bone impaction has not been reported in pediatric patients. Case description: A 10-year-old Chinese girl presented with right sided abdominal pain and fever. Abdominal examination revealed tenderness and guarding in the right iliac fossa. She was initially thought to have acute appendicitis. Ultrasound of the abdomen was not conclusive. A computed tomography of the abdomen with contrast revealed that the appendix was not dilated. It also showed a faint 1.3-cm-long linear hyper-density in the cecum, with peritoneal thickening at the right iliac fossa. Laparoscopy confirmed a fish bone impaction causing cecal perforation. The fish bone was retrieved, and the cecal perforation repaired through a McBurney incision. She was discharged 3 days after operation. Conclusion: Although rare, it is important to consider the possibility of an intestinal perforation caused by swallowed foreign objects such as fish bone in children presenting with acute abdominal pain.