But accidental ingestion of fishbone can have complications!
The chances of a fishbone being a health hazard are quite thin. It is rare to see a fishbone perforating the walls of the digestive tract in otherwise healthy individuals.
More than 90% of the ingested foreign bodies that reach the stomach pass through, without eliciting any symptoms or without causing impaction. However, around 1% of the patients require surgery for managing gastrointestinal perforation secondary to an ingested foreign body. Endoscopic removal is required in another 10–20% of the patients.
Fishbone bowel perforation is most commonly seen in the ileocecal and rectosigmoid regions.
One such rare case was reported when a 73-year-old man presented to the emergency department with complaints of severe lower abdominal pain, which started abruptly. The patient could not recall any precipitating event on the day of presentation; however, he recalled eating yellowtail fish one day before his presentation to the ED.
On examination, his vitals showed a normal blood pressure of 122/69 mm Hg, a heart rate of 77 beats per minute, and a body temperature of 100.4°F (38°C). Abdominal examination revealed tenderness across the lower abdomen with rebound tenderness.
A complete blood count result showed an increased white cell count of 10,300/ mm3 (reference range, 3300 to 8600) with 83% neutrophils.
Perforation was suspected. Since computed tomography is the method of choice for identifying ingested FBs, an abdominal CT scan was performed. It revealed a linear, high-density body penetrating the small intestine. The thickened gut wall was seen on the scan too. (Panel A).
Surgical exploration via laparotomy was performed. A 2 cm long fishbone was recovered, which had resulted in the perforation of the small bowel (Panel B). The affected portion of the small intestine was resected. The patient was given antibiotics.
Both the intra- and postoperative periods were uneventful, and the patient was discharged 8 days after the surgery.
Alex M Almoudaris, A. C. (2011, December). Fish Bone Perforation Mimicking Acute Appendicitis. Journal of Medical Cases, 2, 296-299. Retrieved from Journal of Medical cases: https://www.journalmc.org/index.php/JMC/article/view/151/246
Takafumi Taguchi, M. P. (2019, August 22). Fish Bone Perforation. Retrieved from The New England Journal of Medicine: https://www.nejm.org/doi/full/10.1056/NEJMicm1900442
Choi, Y., Kim, G., Shim, C., Kim, D., & Kim, D. (2014). Peritonitis with small bowel perforation caused by a fishbone in a healthy patient. World journal of gastroenterology, 20(6), 1626–1629. https://doi.org/10.3748/wjg.v20.i6.1626