Peritonitis with small bowel perforation caused by a fish bone in a healthy patient

Perforation of the gastrointestinal tract by ingested foreign bodies is extremely rare in otherwise healthy patients, accounting for < 1% of cases. Accidentally ingested foreign bodies could cause small bowel perforation through a hernia sac, Meckel’s diverticulum, or the appendix, all of which are uncommon. Despite their sharp ends and elongated shape, bowel perforation caused by ingested fish bones is rarely reported, particularly in patients without intestinal disease. We report a case of 57-year-old female who visited the emergency room with periumbilical pain and no history of underlying intestinal disease or intra-abdominal surgery. Abdominal computed tomography and exploratory laparotomy revealed a small bowel micro-perforation with a 2.7-cm fish bone penetrating the jejunal wall.

Esophageal perforation caused by fish vertebra ingestion in a seven-month-old infant demanded surgical intervention: A case report

A seven-month-old infant was admitted to our hospital with a 1-wk history of shortness of breath, dysphagia, and fever. Diagnosis of esophageal perforation follow- ing fish vertebra ingestion was made by history review, pneumomediastinum and an irregular hyperdense lesion noted in initial chest radiogram. Neck computed tomo- graphy (CT) confirmed that the foreign body located at the cricopharyngeal level and a small esophageal tra- cheal fistula was shown by esophagogram. The initial re- sponse to treatment of fish bone removal guided by pan- endoscopy and antibiotics administration was poor since pneumothorax plus empyema developed. Fortunately, the patient’s condition finally improved after decortica- tion, mediastinotomy and perforated esophagus repair. To our knowledge, this is the first case report of esopha- geal perforation due to fish bone ingestion in infancy. In addition to particular caution that has to be taken when feeding the innocent, young victim, it may indicate the importance of surgical intervention for complicated esophageal perforation in infancy.

Medical treatment for a fish bone-induced ileal micro-perforation:A case report

Ingested fish bone induced intestinal perforations are seldom diagnosed preoperatively due to incomplete patient history taking and difficulties in image evidence identification.Most literature suggests early surgical intervention to prevent sepsis and complications resulting from fish bone migrations.We report the case of a 44-year-old man suffered from acute abdomen induced by a fish bone micro-perforation.The diagnosis was supported by computed tomography(CT) imaging of fish bone lodged in distal ileum and a history of fish ingestion recalled by the patient.Medical treatment was elected to manage the patient's condition instead of surgical intervention.The treatment resulted in a complete resolution of abdominal pain on hospital day number 4 without complication.Factors affecting clinical treatment decisions include the nature of microperforation,the patient's good overall health condition,and the early diagnosis before sepsis signs develop.Micro-perforation means the puncture of intestine wall without CT evidence of free air,purulent peritoneum or abscess.We subsequently reviewed the literature to support our decision to pursue medical instead of surgical intervention.

Fish bone migration to the urinary bladder after rectosigmoid colon perforation

Fish bones are the most common foreign objects leading to bowel perforation.Most cases are confined to the extraluminal space without penetration of an adjacent organ.However,abscess formation due to the perforation of the rectosigmoid colon by a fish bone can lead to the penetration of the urinary bladder and may subsequently cause the fish bone to migrate into the urinary bladder.In the presented case,a 42-yearold female was admitted for lower abdominal pain.The computed tomography(CT)demonstrated a 5cm pelvic abscess containing a thin and curvilinear foreign body.After conservative management,the patient was discharged.After 1 mo,the subject developed a mechanical ileus.Surgery had to be delayed due to her hyperthyroidism.Migration of the foreign body to the urinary bladder was shown on additional CT.A Yellowish fish bone 3.5 cm in size was removed through intraoperative cystoscopy.The patient was discharged 8 d after the operation without any unexpected event.

Small-bowel perforation caused by fish bone

A diagnosis of small-bowel perforation, caused by a sharp or pointed foreign body, is rarely made preoperatively because the clinical symptoms are usually nonspecific and can mimic other surgical conditions, such as appendicitis and diverticulitis. We report the case of a 62-year-old woman who experienced severe pain in the right iliac fossa and fever for about five days before arrival at our hospital. The presumptive diagnosis was acute purulent appendicitis and an emergency appendectomy was planned. Swelling and erythema were noted in a segment of the small bowel in the lower right abdomen. A tiny pointed object was found penetrating the inflamed portion of the bowel, which proved to be a sharp fish bone (gray snapper). The bone was removed, followed by segmental resection of the terminal ileum and ascending colon. The postoperative course was uneventful.

Appendicitis-mimicking presentation in fishbone induced microperforation of the distal duodenum:A case report

BACKGROUND Upper gastrointestinal fishbone microperforations are rare and not commonly reported in medical literature.Despite the increasing use of computer tomography(CT)imaging and the employment of the Alvardo criteria,misdiagnosis of acute appendicitis can still occur.We report the rare case of an elderly Chinese gentleman who had a fish-bone induced microperforation of the duodenum that closely mimicked the symptoms of acute appendicitis.CASE SUMMARY This 79-year-old man presented with migratory lower abdominal pain that localized at his periumbilical region and right lower quadrant.He had associated pyrexia,general malaise and was noted to have an elevated white cell count.CT investigations initially revealed a distended appendix which was resected laparoscopically but showed no obvious signs of gross inflammation.The patient then deteriorated clinically and had increased oxygen requirements immediately after the surgery.This prompted further investigations.A further review of his CT scan revealed a fine fishbone microperforation in the distal duodenum associated with retroperitoneal abscess formation and seepage extending into the right lower quadrant.He was then started on broad spectrum intravenous antibiotics and subsequently underwent a laparotomy 12 h later to manage the obscure aetiology and to drain the abscess.The post-operative course was uneventful and he was discharged 11 d later including a 2-d stay in the intensive care unit.CONCLUSION This case offers an insight into a potential mimic of acute appendicitis and the diagnostic difficulties experienced in such presentations.

Valorization of a Good Bioceramic from Moroccan Waste Fish Bone by a Heat Treatment Method

A tricalcium phosphate(TCP)material was produced from sardine and mackerel waste using a heat treatment method after a Soxhlet extraction to obtain the non-soluble portion of fish waste.The bones were annealed at temperatures between 400℃ and 1200℃.The thermal analysis(TG-DTA)was carried out to investigate the thermal stability of TCP and to confirm the removal of organic matter from the raw fish.The calcined bones were characterized by Fourier transform infrared spectroscopy(FT-IR),X-ray diffraction(XRD),and field emission scanning electron microscopy(FESEM).The calcium to phosphorous weight ratio was determined by ICP-AES.FT-IR and XRD confirmed the similarities to syntheticβ-TCP(JCPDS-09-169),FE-SEM results revealed the formation of nanostructured TCP.These results suggest that varying the isolation temperature between 600-1200℃ has tremendous impact on the production of TCP from fish bone waste with the required properties.

Surgical treatment of delayed cervical infection and incomplete quadriplegia with fish-bone ingestion:A case report

BACKGROUND The most commonly ingested foreign body in Asians is fish bone.The vast majority of patients have obvious symptoms and can be timely diagnosed and treated.Cases of pyogenic cervical spondylitis and diskitis with retropharyngeal and epidural abscess resulting in incomplete quadriplegia due to foreign body ingestion have been rarely reported.The absence of pharyngeal or esophageal discomfort and negative computed tomography(CT)findings of fish bone have not been reported.We report the case of an elderly female patient with delayed cervical infection and incomplete quadriplegia who had a history of fish bone ingestion.CASE SUMMARY A 73-year-old woman presented with right neck pain and weakness of four limbs for a week,and had a history of fish bone ingestion and negative findings on laryngoscopic examination one month previously.She did not complain of any pharyngeal or esophageal discomfort.Cervical magnetic resonance imaging showed C4/C5 spondylitis and diskitis along with retropharyngeal and ventral epidural abscesses.No sign of fish bone was detected on lateral cervical radiography and CT scans.The muscle strength of the patient’s right lower limb receded to grade 1 and other limbs to grade 2 suddenly on the 10th day of hospitalization.Emergency surgery was performed to drain the abscess and decompress the spinal cord by removing the anterior inflammatory necrotic tissue.Simultaneously,flexible esophagogastroduodenoscopy was carried out and a hole in the posterior pharyngeal wall was found.The motor weakness of the right lower limb improved to grade 3 and the other limbs to grade 4 within 2 d postoperatively.CONCLUSION This rare case highlights the awareness of the posterior pharyngeal or esophageal wall perforation in patients with cervical pyogenic spondylitis along with a history of fish bone ingestion,even though local discomfort symptoms are absent and the radiological examinations are negative.

Pylephlebitis—a rare complication of a fish bone migration mimicking metastatic pancreatic cancer:A case report

BACKGROUND Pylephlebitis is a rare condition,poorly recognized by clinicians and with few references.In this case,the clinical appearance resembled the clinical course of a pancreatic cancer and was originated by the ingestion of a fish bone,making the case more interesting and rare.CASE SUMMARY A 79-year-old female presented to the emergency department with fever,loss of appetite and jaundice.Tenderness in the right upper quadrant was present.Inflammation marker were high.A computed tomography(CT)scan revealed gallstones and aspects compatible with acute pancreatitis.The patient was admitted to surgery ward and has her condition aggravated.A magnetic resonance revealed multifocal liver lesions.Later,a cholangiopancreatography and an endoscopic ultrasound(US)were able to diagnose the condition.Specific treatment was implemented and the patient made a complete recovery.CONCLUSION In conclusion,this case report demonstrates for the first time the diagnosis of an unusual case of pylephlebitis complicated by the migration of a fish bone,mimicking metastatic pancreatic cancer.Clinical presentation and traditional imaging studies,such as transabdominal US and CT,remain the standard for diagnosing this condition.

Gastric submucosal lesion caused by an embedded fish bone:A case report

BACKGROUND Submucosal tumors(SMTs)refer to elevated lesions that originate from the layers below the mucosa of the digestive tract,including the muscularis,submucosa and muscularis propria.With the development and application of endoscopy and endoscopic ultrasonography(EUS),the detection rate of SMTs has increased significantly in recent years.Various diseases can lead to SMTs.However,a foreign body embedded in the gastric antrum showing clinical manifestations of a SMT is rare.CASE SUMMARY We report the case of a 47-year-old woman,who presented with upper abdominal discomfort for one year,and was subsequently diagnosed with a gastric submucosal lesion caused by an embedded foreign body by EUS and computed tomography.Considering the size and potential complications of this lesion,endoscopic full-thickness resection was performed to achieve full resection in our endoscopy center.A fish bone was found in the lesion during the operation,and was successfully removed,and the defect was later closed with endoscopic pursestring sutures.CONCLUSION This case report highlights the management strategies of SMTs,the importance of being familiar with diagnostic methods related to submucosal lesions,and being able to conduct effective treatment when this rare condition is highly suspected.

Laparoscopic treatment of pyogenic liver abscess caused by fishbone puncture through the stomach wall and into the liver:A case report

BACKGROUND Pyogenic liver abscess(PLA)due to foreign body penetration of the gastrointestinal tract is rare but can lead to serious consequences if not diagnosed and managed properly.We report a case of PLA caused by a fishbone puncture.CASE SUMMARY This report describes the clinical features,diagnosis and treatment of a 56-yearold male patient who presented with severe pneumonia,acute respiratory failure and septic shock.The main clinical manifestation was a nonspecific recurrent infection.Based on the findings of abdominal computed tomography examination and the detailed medical history,the diagnosis was made as PLA which was caused by fishbone puncture through the stomach wall and into the liver.After active anti-inflammatory treatment,the patient’s general condition had improved.The laparoscopic drainage of the liver abscess and the foreign body removal was performed.There was no recurrence of abscess at discharge or during follow-up and the patient’s general condition was satisfactory.CONCLUSION PLA caused by foreign bodies usually requires surgical treatment or percutaneous drainage combined with antibiotics.Our case confirms that a laparoscopic approach is safe and feasible for such cases.

Misdiagnosis of food-borne foreign bodies outside of the digestive tract on magnetic resonance imaging:Two case reports

BACKGROUND Patients with foreign bodies in the digestive tract are often encountered,but complete penetration of a foreign body through the gastrointestinal tract is rare,and the choice of imaging method is very important.Improper selection may lead to missed diagnosis or misdiagnosis.CASE SUMMARY An 81-year-old man was diagnosed as having a liver malignancy after he took magnetic resonance imaging and positron emission tomography/computed tomography(CT)examinations.The pain improved after the patient accepted gamma knife treatment.However,he was admitted to our hospital 2 mo later due to fever and abdominal pain.This time,he received a contrast-enhanced CT scan,which showed fish-boon-like foreign bodies in the liver with peripheral abscess formation,then he went to the superior hospital for surgery.It lasted for more than 2 mo from the onset of the disease to the surgical treatment.A 43-year-old woman with a 1 mo history of a perianal mass with no obvious pain or discomfort was diagnosed as having an anal fistula with the formation of a local small abscess cavity.Clinical perianal abscess surgery was performed,and fish bone foreign body was found in perianal soft tissue during the operation.CONCLUSION For patients with pain symptoms,the possibility of foreign body perforation should be considered.Magnetic resonance imaging is not comprehensive and that a plain computed tomography scan of the pain area is necessary.

A rare cause of acute abdomen after a Good Friday

Small bowel perforation caused by an ingested fish bone is rare but can involve the appendix or Meckel’s diverticulum.We report the case of a 25-year-old man who presented to the emergency department with acute abdomen caused by perforation of a Meckel’s diverticulum with a fish bone ingested in a Good Friday.

Biomimetic Lightweight Design of Legged Robot Hydraulic Drive Unit Shell Inspired by Geometric Shape of Fish Bone Rib Structure

The lightweight design of hydraulic quadruped robots,especially the lightweight design of the leg joint Hydraulic Drive Unit(HDU),can improve the robot's response speed,motion speed,endurance,and load capacity.However,the lightweight design of HDU is a huge challenge due to the need for structural strength.This paper is inspired by the geometric shape of fish bones and biomimetic reinforcing ribs on the surface of the HDU shell are designed to increase its strength and reduce its weight.First,a HDU shell with biomimetic fish bone reinforcing ribs structure is proposed.Then,the MATLAB toolbox and ANSYS finite element analysis module are used to optimize the parameters of the biomimetic reinforcing ribs structure and the overall layout of the shell.Finally,the HDU shell is manufactured using additive manufacturing technology,and a performance testing platform is built to conduct dynamic and static performance tests on the designed HDU.The experimental results show that the HDU with biomimetic fish bone reinforcing ribs has excellent dynamic performance and better static performance than the prototype model,and the weight of the shell is reduced by 20%compared to the prototype model.This work has broad application prospects in the lightweight and high-strength design of closed-pressure vessel components.

Analysis of Bio-inspired Fishbone Based Corrugated Rib for Adaptive Camber Morphing

Bioinspired active camber morphing is an innovative solution for the aerodynamic performance enhancement of flight vehicles such as Micro Aerial Vehicles(MAVs)and Unmanned Aerial Vehicles(UAVs).In the present article,a bio-inspired Fish Bone Active Camber(FishBAC)corrugated rib design concept with and without a spine for an Unmanned Aerial Vehicle(UAV)is proposed.The wing model is composed of multiple corrugated ribs and a splitted spar for connecting each rib.The rib geometry is subjected to static structural analysis using ANSYS Finite Element Analysis(FEA)module under the unit load conditions.The deformation modes are first extracted from the solution of the wind tunnel test and the elastically deformed NACA 4412 profile will be used to perform Fluid-Structure Interaction(FSI)studies as a partly coupled analysis.FishBAC corrugated rib with spine design is a stable structure as inspired from nature species that can withstand elastic and inertial loads.Computational fluid dynamics(CFD)simulation is performed to compute the coefficient of lift(Cl),coefficient of drag(Cd)at different Angle of Attack(AoA)for a modified NACA 4412 airfoil and the pressure loads acting on the deformed shape is extracted.The Cl obtained for the modified airfoil at lower AoA is about 60–80%higher and the maximum Cl(Clmax)is 62%higher than the baseline airfoil.The Cd of modified airfoil is reduced about 20%at the AoAα=3°as compared with the baseline model.The proposed corrugated rib structure has been successfully 3D printed with Polylactic Acid plus(PLA+)material and the wind tunnel testing is done to validate the Cl,Cd values obtained through CFD simulations and the results are presented.

Bone Fishing World团队深入蒙古草原——蒙古无人区探路冷水路亚对象鱼类纪实

在我看来,一个人如果想要出去散心,海洋与草原颇为相似。而对于一个酷爱钓鱼的人来说,在心中郁闷的时候,只要去那样的地方做一次深呼吸,然后纵情挥上几竿,定会把一切烦恼抛到脑后。在去年9月,我们Bone Fishing World团队有幸走进蒙古大草原,也真正体验到了来自蒙古大草原河流之中的冷水路亚对象鱼。我们这次去蒙古钓鱼是一次比较特别的经历。

Co-inoculation of Lactiplantibacillus pentosus 1 and Saccharomyces cerevisiae 31 for a salt-free fish sauce production from channel catfish (Ietalurus punetaus) bone

The study aimed to evaluate the co-inoculation of non-fish sauce strains for a fish sauce production made from Ietalurus punetaus fish bone hydrolysate (FBH) without salt addition. Individual inoculation (Lactiplantibacillus pentosus 1, LP and Saccharomyces cerevisiae 31, SC), and co-inoculation of both strains (FS) were employed, including an uninoculated control. Both strains exhibited good growth in FBH without salt addition. Compared with individual inoculation and uninoculated control, co-inoculation (FS) produced acid and amino nitrogen more quickly, as well as displaying higher sugar consumption. No significant difference was observed in trichloroacetic acid (TCA)-soluble peptides among all groups (P > 0.05). Moreover, significantly lower levels of six bitter amino acids were observed after co-fermentation (P < 0.05). In addition, more alcohols, esters and acids with pleasant notes and fewer unsaturated aldehydes with fishy note were generated after co-inoculation, in the absence of traditional fish sauce off-odor notes. The study demonstrated that the co-inoculation of non-fish sauce strains were appropriate for producing a salt-free fish sauce with better flavor.