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Answer to Photo Quiz: An unusual cause of chronic abdominal symptoms

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Abdominal CT showed extensive diverticulosis and a linear foreign body lodged in the wall of the sigmoid colon, with wall thickening and local infiltration. The foreign body, a chicken bone, was removed by endoscopy. The patient made a full recovery.
Foreign body ingestion (FBI) is common,1 and 80% of ingested foreign bodies pass through the gastrointestinal tract without complications.2 However, these can cause obstruction, perforation or haemorrhage, or fistula formation. Perforation is experienced by only 1% of patients.3 This is usually the result of a sharp object, such as a chicken or fish bone. Perforation usually occurs at the ileocecal junction or in the sigmoid colon.2
Most patients do not provide a history of FBI. It is more common in children, the elderly, alcoholics and the mentally handicapped.1 Risk factors for FBI include the presence of dentures or sensory defects. Previous gastrointestinal surgery and diverticulosis are the most important risk factors for complications following ingestion.2
Patients presenting with an acute abdomen may undergo emergency surgery, usually due to a high suspicion of, for instance, appendicitis. As our patient presented with a two-month history of abdominal pain, an altered defecation pattern and weight loss, FBI was not immediately suspected. We reviewed the earlier performed abdominal CT; in retrospect, the foreign body was present. We therefore posited that the chicken bone had been lodged in the intestinal wall for a longer period.3
Plain radiographs can suggest a foreign body; however, CT scans are more informative.4 Once the foreign body has passed through the stomach, asymptomatic patients can safely be observed, as 80% of foreign bodies will then pass without further complications.2
When peritonitis following perforation is caused by a foreign body, an exploratory laparotomy may be performed. Our patient was not diagnosed with peritonitis, nor with perforation by a foreign body. He did not present with an acute abdomen, but rather with chronic, recurrent abdominal pain, a change in defecation pattern, and weight loss.  


  1. 1. Kibrell FT Jr, Tepas JJ 3d, Mullen JT. Chicken bone perforation of the sigmoid colon: A report of three cases. Am Surg. 1975;41:814-7. 
  2. 2. Cleator IG, Christie J. An unusual case of swallowed dental plate and perforation of the sigmoid colon. Br J Surg. 1973;60:163-5. 
  3. 3. Goh BK, Chow PK, Wuah HM, Ong HS, Eu KW, Ooi LL, Wong WK: perforation of the gastrointestinal tract secondary to ingestion of foreign bodies. World J Surg. 2006,30:372-7. 
  4. 4. Webb WA. Management of foreign bodies of the upper gastrointestinal tract: update. Gastrointest Endosc. 1995;41:39-51.