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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Published online: October 12, 2012Lawrence J. Brandt, MD, Associate Editor for Focal Points
© 2013 Published by Elsevier Inc.