腹膜刺激症状により発症した魚骨による回腸穿孔の一例

Abstract

We report herein a rare case of ileum perforation by fish bone associated with severe manifestations of peritonitis. A 54-year-old man with chronic hepatitis C (CHC) and nephrotic syndrome was admitted into our hospital to receive interferon therapy. A couple of days after admission, he suddenly complained of a severe abdominal pain with diffuse tenderness. Enhanced computed tomography revealed an ileum perforation by a sharp thin object. Since he had severe clinical manifestations of peritonitis, an emergency operation was performed. This surgery revealed an ileum perforation by needle-like material and opaque ascites. Histological examination showed acute mucosal inflammation of the ileum with a fish bone. In most cases, the perforation hole is small, and the main clinical manifestation is usually localized limited abdominal pain but not diffuse tenderness. In these cases, conservative therapies such as endoscopic approach can be selected but not an emergency operation. However, when there is ascites, severe peritonitis can immediately result from leak of several toxic substances such as the ileum juice, endotoxin, and microbacteria into the peritoneal cavity. We have to take into account that even a small perforation by a fish bone may rapidly cause diffuse peritonitis under the condition of ascites such as nephrotic syndrome.