Foreign Body (Chicken Bone)
 Perforation of Bowel

 

 

General Considerations

• Overall, most ingested foreign bodies occur in children
• Perforation occurs in less than 1% of ingested foreign bodies
• Known agents include chicken and fish bones, toothpicks, dentures and cocktail sticks
• Blunt foreign bodies may also perforate through a slower process of pressure necrosis of the bowel wall
• Most patients don’t remember ingesting the foreign body
• At greater risk are:
• The elderly
• Those wearing dentures
• Patients with bowel strictures
• Alcoholics and psychiatric patients

Clinical Findings

• Pain
• Nausea
• Vomiting
• Fever

Imaging Findings

• CT is most useful in finding the foreign body and the reaction to them
• Most common site of perforation is terminal ileum (83%) and colon
• Visualization of the foreign body outside of the bowel lumen
• Thickening of the bowel wall
• Surrounding inflammatory reaction
• Small amounts of loculated extraluminal air
• Free air is not common

Differential Diagnosis

• Appendicitis
• Diverticulitis

Treatment

• Treatment usually involves surgical resection or repair of the bowel

Complications

• Fistula formation
• Inflammatory mass
• Acute abdomen