Posts Tagged ‘appendicitis’

Cases Network – Image of the month

August 18, 2009

Every month we select an image from Cases Journal or the Journal of Medical Case Reports (JMCR) that we feel is that little bit extra special.

Below is our choice for this month:

Photograph showing the sigmoid colonic perforation. Figure taken from Joglekar et al., "Sigmoid perforation caused by an ingested chicken bone presenting as right iliac fossa pain mimicking appendicitis: a case report"

Photograph showing the sigmoid colonic perforation. Figure taken from Joglekar et al., "Sigmoid perforation caused by an ingested chicken bone presenting as right iliac fossa pain mimicking appendicitis: a case report"

Sigmoid colonic perforation is an acute surgical emergency.

The patient in this case presented with a 3-day history of colicky generalised abdominal pain, gradually getting worse and eventually localising to the right iliac fossa (classical symptoms of acute appendicitis).

A provisional diagnosis of acute appendicitis was made, and consent was taken for appendicectomy. During the operation, a small (2 mm) perforation was found in the distal sigmoid colon through which a chicken bone was protruding outward.

Fewer than 1% of ingested foreign bodies will perforate the bowel. Although most sharp objects pass without complications, once beyond the oesophagus, they carry an increased risk of complications.

Diagnosis of an intestinal perforation can be difficult and the authors emphasise the need for a high degree of suspicion and awareness on the part of the clinician. They stress that situations such as these highlight the importance of obtaining full consent from the patients; this is particularly important when there is a diagnostic dilemma, as this may have future medico-legal implications. It is important to inform patients about an alternative diagnosis.

Our deputy editor said: “Excellent and intreresting case, also very well written“.

For all the clinical details, read the full case report here.

Title: “Sigmoid perforation caused by an ingested chicken bone presenting as right iliac fossa pain mimicking appendicitis: a case report”

Authors: Sandeep Joglekar, Iqbal Rajput, Sachin Kamat and Sarah Downey

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