A Case of Ileum Perforation Caused by Ingested Fish Bone Presumably Due to Indigestion after Total Gastrectomy.
10.2185/jjrm.51.47
- VernacularTitle:胃全摘術後による消化不良が原因であると考えられた回腸魚骨穿孔の１例
- Author:
Noriyuki HIRAHARA
;
Hiroaki WATANABE
- Publication Type:Journal Article
- From:Journal of the Japanese Association of Rural Medicine
2002;51(1):47-51
- CountryJapan
- Language:Japanese
-
Abstract:
This paper deals with a case which was firmly diagnosed as ileum perforation caused by an ingested fish bone during an emergency operation for acute appendicitis.
A 49-year-old man was referred to our hospital because of right lower abdominal pain. On close exploration, acute appendicitis was suspected, and an emergency laparotomy was performed. During the operation, we confirmed redness and swelling of the appendix, thickening of the mesoappendix, and typical presentations of appendicitis. Moreover, there was massive retention of blood in the small intestine, and an intestine about 20cm from the terminal ileum was adherent to the inside of the right common iliac artery. When the adhesion was dissected, a fish bone was detected. From these findings, it was thought that iliac perforation due tothe fish bone had involved the appendix. Appendectomy and a partial excision of the ileum were performed.
It was inferred that, since the patient had previously undergone a total gastrectomy with Roux-en Y reconstruction, there was no secretion of gastric juice, resulting in poor digestion of the fish bone. Though the fish bone could be easily evacuated to the small intestine because of a lack of physiological barriers such as the pyrolic ring, it was considered, the perforation occurred because of astricture of the intestine caused by adhesion.
