AJR 2001; 176:152
© American Roentgen Ray Society
Radiologic-Pathologic Conferences of the
Massachusetts General
Hospital |
Colonic Perforation by Ingested Chicken Bone
Amjad A. Rasheed1,
Vikram Deshpande2 and
Priscilla J. Slanetz1
1
Department of Radiology, Massachusetts General Hospital and the Harvard
Medical School, 15 Parkman St., Boston, MA 02114.
2
Department of Pathology, Massachusetts General Hospital and the Harvard
Medical School, Boston, MA 02114.
Received May 25, 2000;
accepted after revision June 28, 2000.
From the weekly radiologic-pathologic conferences of the Massachusetts
General Hospital conducted by Theresa C. McLoud.
Address correspondence to P. J. Slanetz.
Introduction
A 59-year-old man with a history of colonic diverticulosis presented with
severe left lower quadrant pain and fever of several days' duration.
Unenhanced radiography of the abdomen showed dilated loops of small bowel with
air-fluid levels more consistent with small-bowel obstruction rather than
ileus. CT with oral and IV contrast material showed free intraperitoneal air,
dilated loops of small bowel without a definite transition point, and sigmoid
diverticulosis (Fig. 1A). The
patient underwent resection of the involved segment of the sigmoid colon.
Pathology revealed colonic perforation caused by a chicken bone in the setting
of sigmoid diverticulitus (Figs.
1B and
1C).
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Fig. 1A. —59-year-old man with left lower quadrant pain and fever
caused by sigmoid perforation from ingested chicken bone. CT scan of pelvis
shows free intraperitoneal air (curved arrows), diverticula
(straight white arrow), and extensive inflammation (long black
arrow) around sigmoid colon. Linear opacity in sigmoid colon represents
perforating chicken bone (short black arrow).
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Fig. 1B. —59-year-old man with left lower quadrant pain and fever
caused by sigmoid perforation from ingested chicken bone. Photograph of
pathologic specimen shows resected sigmoid colon with perforating chicken bone
(arrows).
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Fig. 1C. —59-year-old man with left lower quadrant pain and fever
caused by sigmoid perforation from ingested chicken bone. Photomicrograph
shows perforation tract (open arrows) with adjacent inflammation
(solid arrow). (H and E, x100)
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Intestinal perforation occurs in fewer than 1% of cases of ingestion of
foreign bodies [1]. To make the
diagnosis preoperatively, clinical suspicion must be high because many medical
conditions can simulate this abnormality. Colonic diverticulitis or previously
unsuspected colon carcinoma have been reported as secondary findings in cases
of sigmoid perforation caused by chicken bones
[1,
2]. Even colovesical or
colorectal fistulas have been reported as being caused by ingested chicken
bones [3,
4]. Small-bowel perforation has
also been previously reported
[5].
Most perforations occur at narrowings and angulations. Eighty-three percent
of foreign-body perforations occur in the ileum
[6]. Foreign-body perforations
are more common in elderly patients who wear dentures, patients who have a
mental impairment, and patients who chronically abuse alcohol. Although the
imaging findings can be nonspecific, the identification of a chicken bone with
an associated mass or extraluminal collection of gas in patients with clinical
signs of peritonitis, mechanical bowel obstruction, or pneumoperitoneum
strongly suggests the diagnosis
[6,
7]. Prompt surgical treatment
to prevent abscess formation is usually indicated.
References
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Read TE, Jacono F, Prakash C. Coloenteric fistula from chicken bone
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Maglinte DD, Taylor SD, Ng AC. Gastrointestinal perforation by
chicken bones. Radiology
1979;130:597
-599[Abstract]
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Introduction
References
