Fish bone ingestion: Complications and legal implications

Foreign body (FB) ingestion, which can be accidental or intentional, is quite common, especially in children, elderly and some categories of profession. On the other hand, perforation and abscess formation as complications of FB ingestion are rare. Their presentation is not clinically different from other causes of peritonitis and differential diagnosis is sometimes difficult. The most common cause of FB perforation is due to fish bone ingestion. We present two consecutive cases of complications associated to fish bone ingestion. In the first case, patient had diffused abdominal pain, without laboratory considerable signs of inflammation. Computer tomography (CT) scan evidenced ileal perforation due to a probable FB; in the second case patient presented abdominal pain, leukocytosis and elevated CRP. The CT scan revealed presence of abscess and omental inflammation near ileum. Both patients submitted surgery. In the first case, an enterotomy was done, in the second case omentectomy and abdominal cleaning were performed. Surprisingly, In the second case, the patient claimed for damages in the high suspicion for a medical error occurred in a previous operation. Fortunately, the specimen exam revealed the truth. Complications due to FBs ingestion must be adequately recognized and rapidly treated. Radiological tools, especially ultrasonography and CT scan, can be useful to make diagnosis but sometimes this is reached only at the time of intervention.