A 67-year-old diabetic man presented with 6 days of dull abdominal pain in the left
lower quadrant that was aggravated by movement. The pain was associated with nausea
but no vomiting. The patient reported chills, but he was afebrile. Examination was
significant only for left-sided abdominal tenderness with voluntary guarding. The
white blood cell count was normal. A CT scan of the abdomen revealed mesenteric stranding
adjacent to a loop of jejunum and a small amount of adjacent free air. There was no
fluid collection. These findings were compatible with an inflammatory process adjacent
to the loop of jejunum, perhaps caused by a sealed perforation (A). Double-balloon–assisted enteroscopy revealed a small superficial ulcer in the mid-jejunum,
with a foreign body protruding from the center of the ulcer (B). The foreign body was removed by using a snare (Video 1, available online at www.giejournal.org). The jejunum was tattooed using India ink in case the patient required surgical
intervention. On inspection of the foreign body, it was found to be a fish bone (C). The patient reported that he ate a dinner of common carp (Cyprinus carpio) 1 week before admission, although he did not recall swallowing a fish bone or having
any discomfort after the meal. The patient recovered after the procedure and was discharged
the next day to resume his usual diet.
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Article info
Publication history
Published online: October 12, 2012
Lawrence J. Brandt, MD, Associate Editor for Focal PointsIdentification
Copyright
© 2013 Published by Elsevier Inc.
