Early presentation of bowel perforation due to fish bone ingestion

An 83-year-old man presented to our clinic with diffuse abdominal pain for 6 h. Physical examination revealed diffuse abdominal tenderness with muscle guarding, especially in left lower quadrant. Laboratory tests showed leukocytosis with 88% neutrophils. Computed tomography (CT) scan showed perforated jejunum by a 2.5 cm high-density linear opacity without apparent pneumoperitoneum or focal mesenteric fat inflammation (Figure 1, white arrow). Exploratory laparotomy confirmed jejunum penetrated by the fish bone (Figure 1, black …