Perforation by chicken bone in incarcerated intestinal loop of incisional hernia

Abstract

Introduction: Ingestion of foreign bodies is a frequent reason for consultation. In 80 % of the cases these go unnoticed and without discomfort through the digestive tract. They may have multiple sizes and shapes, but the thin, hard and sharp ones such as fish bones, chicken bones or toothpicks, tend to stop at narrower locations in the digestive tract. Since they are points of impact, they can cause an intestinal perforation and debut with acute peritonitis that will require early diagnosis and surgery. Case report: We present a clinical case of a 56-year-old female patient, who had abdominoplasty and hernioplasty with a prosthetic mesh for incisional hernia post-cesarean 12 years ago with a recurrence 3 years ago. Consulted in the emergency department for intestinal perforation in herniated loop and bent below the mesh in ileum segment of inci- sional hernia due to a foreign body (chicken bone). She was diagnosed early by abdominal computerized tomography with emergency intestinal resection, and the hernioplasty was deferred because of a localized peritonitis. Discussion: Presentation and diagnosis of this patient constituted a real diagnostic challenge due to the lack of anamnestic data on foreign body intake, with symptoms suggestive of a stuck incisional hernia. Diagnosis by tomog- raphy helped in the diagnostic certainty and the early surgery. Kinking of herniated loop served as an impact point for the perforation and local peritonitis forced the mesh placement to be deferred. We must remember the possibility of a foreign body as a cause of obstruction and an acute abdomen due to intestinal perforation in certain types of patients (elderly, bad teeth, etc.) in order to avoid unnecessary waiting periods that may delay surgery and increase morbidity. A foreign body can complicate the evolution of a known recurrence.