# Unforeseen consequences: A case report of misdiagnosis in pediatric ingestion of a fish bone

## TL;DR

A 2-year-old boy was misdiagnosed with constipation but later found to have a fishbone perforation, highlighting the risks of delayed diagnosis in foreign body ingestion.

## Contribution

This case report highlights the diagnostic challenges and clinical implications of fishbone ingestion in children.

## Key findings

- The child was initially misdiagnosed with constipation but later found to have a fishbone perforation.
- Computed tomography was critical in identifying the foreign body and associated complications.
- Surgical intervention was required to repair the perforation and remove the abscess.

## Abstract

Children are frequently reported as cases of foreign body ingestion, with fishbone ingestion being particularly prevalent in communities where fish consumption is common. Although many instances of foreign body ingestion resolve spontaneously, the ingestion of sharp objects like fishbones poses a greater risk of morbidity and mortality due to their propensity for causing complications. Furthermore, incidents of foreign body ingestion often present with nonspecific symptoms or may go unnoticed, potentially leading to misdiagnosis and complicating the clinical course. We present a case of a 2-year-old boy initially misdiagnosed with constipation and treated with laxatives due to intermittent progressive abdominal pain. Subsequently, he presented to the emergency department where radiological and laboratory investigations revealed signs of inflammation and localized abdominal fluid collection containing a linear hyperdense object, indicating complicated foreign body ingestion with perforation. Urgent laparotomy revealed an omental abscess, which was excised, and the perforation site was repaired with sutures. This case underscores the risk of misdiagnosis and the importance of timely recognition and management. It also emphasizes the critical role of imaging, particularly computed tomography, in accurate diagnosis and differentiation from other common conditions.