Laparoscopic Appendectomy for Perforated Appendicitis Caused by a Fish Bone: A Case Report

TL;DR

A 76-year-old man had perforated appendicitis caused by a fish bone, diagnosed and treated with laparoscopic surgery.

Contribution

Reports a rare case of fish bone-induced perforated appendicitis and highlights the importance of dietary history and imaging for diagnosis.

Findings

CT and MPR imaging confirmed a fish bone within the perforated appendix.

Laparoscopic appendectomy successfully removed the fish bone and treated the infection.

Histopathology showed severe inflammation and necrosis in the appendix.

Abstract

Foreign body ingestion is relatively common, with most objects passing through the gastrointestinal tract without complications. However, some foreign bodies can cause gastrointestinal perforation, leading to severe complications. Fish bone-induced gastrointestinal perforation is relatively common in regions with high fish consumption, but appendiceal perforation remains extremely rare and diagnostically challenging. We report a case of a 76-year-old male patient who presented with worsening lower abdominal pain. Computed tomography (CT) revealed a swollen appendix (16 mm) with a high-density area and surrounding fat stranding, confirming acute appendicitis caused by appendicolith. Emergency laparoscopic appendectomy revealed a markedly swollen appendix with a central perforation. A 10-mm wedge-shaped fish bone was identified within the appendiceal lumen, confirming fish bone-induced perforated appendicitis. Histopathological examination confirmed severe inflammation with focal necrosis. Postoperative multiplanar reconstruction (MPR) images revealed a wedge-shaped hyperdense linear structure within the appendix, which was identified as a fish bone. Fish bone-induced perforated appendicitis is a rare but important differential diagnosis in regions with high fish consumption. A detailed dietary history and careful review of MPR images on CT are essential for accurate preoperative diagnosis. Early recognition and laparoscopic surgical intervention can prevent severe complications and improve patient outcomes.

Figures