Appendiceal Perforation Secondary to Fish Bone Perforation

Introduction: Ingestion of foreign body occurs commonly, though the majority passes through the gastrointestinal tract uneventfully, rarely causing a perforation. We report a rare case of appendiceal perforation secondary to a fish bone (FB). Material and Methods: A 46-year-old male presented with one-week history of Right Lower Quadrant (RLQ) pain that radiated to the ipsilateral thigh and genital. His vital signs were within normal limits. On physical examination the abdomen was mildly distended with localized RLQ pain, without guarding or peritoneal signs. The white blood count was 9.21 K/UL. A computedtomography revealed inflammatory vascular changes in the anteromedial aspect of the cecum, leading into the base of the appendix. It was thought that this represented the appendicular artery, supporting the diagnosis of vasculitis and/or early appendicitis, though the appendix was not dilated. The patient was admitted for observation, made NPO, started on intravenous fluids, and broad-spectrum antibiotics. Results and Discussion: Because of the persistence of pain, the decision was made to take him to the operating room for a laparoscopic appendectomy. Once pneumoperitoneum was obtained, the appendix was taken down from the anterior abdominal wall, where a FB was protruding and had caused the appendix to adhere. The extra luminal FB was removed, and a standard laparoscopic appendectomy was performed. Conclusion: FB ingestion is uncommon, and rarely causes perforations. Nonetheless, in cases of atypical presentation, this should be considered as a potential cause of abdominal pain and appendix perforation. Appendix perforation secondary to FB can be managed with a laparoscopic approach.