Emergency CT of abdominal complications of ingested fish bones: what not to miss
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Emergency CT of abdominal complications of ingested fish bones: what not to miss Gabriella Souza e Silva 1,2 & Natália Borges Nunes Gomes 1,2 & Eduardo Oliveira Pacheco 1,2 & Flávio Murilo Ribeiro Bezerra 2 & Rafael Borges Nunes 3 & Humberto Lobato Mcphee 3 & Ulysses S. Torres 1,2 Giuseppe D’Ippolito 1,2
&
Received: 10 April 2020 / Accepted: 25 May 2020 # American Society of Emergency Radiology 2020
Abstract Fish bones are the most commonly ingested structures and the most common cause of foreign body perforation of the gastrointestinal tract (GIT). Clinical presentation of foreign body GIT perforation is nonspecific, in many cases with clinical signs of acute abdomen, which can mimic appendicitis, diverticulitis, ulcer peptic disease, and other common inflammatory conditions. Besides, patients commonly do not refer that a fish bone was swallowed. Since this condition is usually not suspected by referring physicians of the emergency department (ED), radiologists play a key role in this diagnosis; the spectrum of these imaging features must be known in order to be accurately reported in the ED. Keywords Fish bone . Foreign body . Gastrointestinal perforation . Emergency . CT
Introduction Fish bones (FB) are the most commonly ingested foreign bodies [1]. Most foreign bodies pass through the gastrointestinal tract within 1 week without symptoms or complications, but perforation can occur in less than 1% of patients, being mainly caused by fish bones [2, 3]. People in extremes of life are more susceptible to foreign body ingestion and its complications than others [1, 4, 5]. Other known risk factors are wearing of dentures (as tactile sensation on the palatal surface is diminished), psychiatric disease, alcohol and drug abuse, and eating rapidly [1, 3–5]. Patients with perforation and other complications of ingested fish bone generally present to the ED with nonspecific symptoms, like abdominal pain, fever, nausea, vomiting, intestinal occlusion or subocclusion, or sepsis [4–7]. They can
* Ulysses S. Torres [email protected] 1
Grupo Fleury, Rua Cincinato Braga, 282, Bela Vista, São Paulo, SP 01333-010, Brazil
2
Hospital São Paulo, Universidade Federal de São Paulo, São Paulo, Brazil
3
Hospital Porto Dias, Belém, Pará, Brazil
also present signs of peritonitis and severe inflammatory alterations on laboratory tests [5]. Once an acute abdomen is diagnosed, the main hypotheses to be considered by clinicians and surgeons are appendicitis, diverticulitis, colitis, cholecystitis, ulcer peptic disease, and other common inflammatory conditions [6, 8–10]. FB perforations may also mimic neoplastic conditions [6, 11]. Patients usually are unaware of having accidentally ingested a fish bone, which also makes the diagnosis difficult [1, 8, 12]. This problem occurs because there may be a time lag of up to some months or even years between ingestion and the onset of symptoms [1, 12]. Therefore, radiologists play an important role in considering this diagnostic hypothesis [1]. The aim of this
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