A CASE OF PERFORATION OF THE ILEUM DUE TO FISH BONE PREOPERATIVELY DIAGNOSED BY CT SCAN

A 61-year-old woman was admitted to the hospital because of abdominal pain. The pain had occurred after a meal of marine animals. There were tenderness and peritoneal sign over a wide area of the lower abdomen. A chest X-ray film revealed a significant sign of gastrointestinal perforation, and an abdominal X-ray film revealed shadow of a fish bone. An abdominal CT scan revealed panperitonitis due to perforation of the small intestine by a linear calcified foreign body. Emergency laparotomy was performed and the perforation in the ileum located 200cm oral from the terminal ileum was comfirmed. The foreign body was recognized in this perforated ileum and removed. It was a fish bone 44mm in length.We can see a considerable number of cases of perforation or penetration of the digestive tract due to a fish bone in the Japanese literature. This case reported here demonstrates that detail collection of patient's history and abdominal CT scan are effective for the preoperative diagnosis.