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Abstract Objective This case report describes an uncommon presentation of epigastric pain from pyloric perforation secondary to ingestion of a fish bone. The objective is to emphasize the need for increased awareness of foreign body ingestion as a differential for acute abdominal pain. Prompt diagnosis and endoscopic intervention is required in cases of gastrointestinal perforation due to foreign bodies. Case We describe a 43-year-old man G with a background of Crohn’s disease presenting with 2 days of epigastric and right upper quadrant abdominal pain, associated with fevers and loose stools. He had signs of epigastric tenderness with localised peritonitis and raised inflammatory markers. G was initially thought to have cholecystitis or Crohn’s flare up hence a computed tomography (CT) was requested, which surprisingly identified a fish bone lodged in the pyloric wall with evidence of localised fat stranding. Urgent gastroscopy performed confirmed a 3cm fish bone lodged in pylorus, which was successfully removed. G recovered well without complications and was discharged on postoperative day three. Discussion Accidental ingestion of fish bones is not uncommon, however, only 1% of cases cause gastrointestinal perforation. We explored the complexities of diagnosing gastrointestinal perforations, the role of CT in localisation and endoscopy as a first line intervention whenever feasible. Conclusions This case report highlights the importance of recognising foreign body perforation as a differential diagnosis in patients with acute abdominal pain and fevers. Endoscopic intervention is valuable in facilitating the extraction of foreign objects with minimal complications.
Tong et al. (Mon,) studied this question.