Frontiers in medicine · 2026
Occult fish bone ingestion inducing cross-site injury: a rare case report of gastric bleeding and jejunal perforation.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Chen Ze-Ming, Cao Guo-Li, Tang Xiao, Gan Ri-Yun, Yu Xi-Qiu
Аннотация
BACKGROUND: Fish bone ingestion is a common clinical problem. However, occult ingestion causing concurrent gastric bleeding and jejunal perforation is extremely rare and easily misdiagnosed.
CASE PRESENTATION: A 72-year-old male presented with upper abdominal pain and hematemesis with no clear history of foreign body ingestion. Abdominal CT revealed a high-density shadow in the stomach, localized gas-fluid accumulation in the small intestine, and minimal surrounding exudation. Emergency gastroscopy failed to identify the source of bleeding. The patient subsequently developed peritonitis, and emergency laparotomy revealed a migratory fish bone that had penetrated the gastric wall and caused secondary jejunal perforation. The patient recovered uneventfully after removal of the fish bone and partial jejunal resection.
DISCUSSION: The mechanism underlying this cross-site injury is as follows: the fish bone first pierced the gastric wall, causing gastric bleeding; it then penetrated the full thickness of the gastric wall and entered the peritoneal cavity, triggering peritonitis; finally, the migrating fish bone punctured the jejunal wall, leading to jejunal perforation and aggravated intra-abdominal inflammation.
CONCLUSION: In elderly patients with abdominal pain and hematemesis but no clear history of foreign body ingestion, rapidly elevated inflammatory markers, progressive peritoneal irritation, and negative gastroscopy should raise strong suspicion of occult fish bone-induced cross-site gastrointestinal injury (gastric bleeding and jejunal perforation). Timely laparotomy is critical for definitive diagnosis and improved prognosis in patients with peritonitis secondary to jejunal perforation. This case provides valuable clinical insights for the early diagnosis and management of similar atypical gastrointestinal injuries caused by fish bone ingestion.
CASE PRESENTATION: A 72-year-old male presented with upper abdominal pain and hematemesis with no clear history of foreign body ingestion. Abdominal CT revealed a high-density shadow in the stomach, localized gas-fluid accumulation in the small intestine, and minimal surrounding exudation. Emergency gastroscopy failed to identify the source of bleeding. The patient subsequently developed peritonitis, and emergency laparotomy revealed a migratory fish bone that had penetrated the gastric wall and caused secondary jejunal perforation. The patient recovered uneventfully after removal of the fish bone and partial jejunal resection.
DISCUSSION: The mechanism underlying this cross-site injury is as follows: the fish bone first pierced the gastric wall, causing gastric bleeding; it then penetrated the full thickness of the gastric wall and entered the peritoneal cavity, triggering peritonitis; finally, the migrating fish bone punctured the jejunal wall, leading to jejunal perforation and aggravated intra-abdominal inflammation.
CONCLUSION: In elderly patients with abdominal pain and hematemesis but no clear history of foreign body ingestion, rapidly elevated inflammatory markers, progressive peritoneal irritation, and negative gastroscopy should raise strong suspicion of occult fish bone-induced cross-site gastrointestinal injury (gastric bleeding and jejunal perforation). Timely laparotomy is critical for definitive diagnosis and improved prognosis in patients with peritonitis secondary to jejunal perforation. This case provides valuable clinical insights for the early diagnosis and management of similar atypical gastrointestinal injuries caused by fish bone ingestion.