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Diagnosis of inflammatory bowel disease is an important issue in gastroenterology. Even with use of the most modern diagnostic methods, it is not always possible to give an unequivocal answer whether the patient suffers from IBD or other intestinal damage occurs. We present a case of perforation of the cecum caused by a chicken bone under the guise of Crohn’s disease.

Case report

A 23-year-old man was admitted in February 2018 with typical clinical features of Crohn’s disease with ileocecal lesion. Colonoscopy data showed ‘knife-cut’ ulcerative defects were revealed in the ileocecal junction; biopsy revealed focal infiltration of neutrophils and deformity of crypts. Test for Cl. Difficile toxins was negative. Despite the treatment with mesalazine (4g per day), budesonide (9mg per day), azathioprine (100mg per day), remission was not achieved. In September 2018, an ileocecal abscess with a size up to 7cm was detected. Due to deterioration of the patient’s condition, we performed resection of the ileocecal junction with formation of ileotransverse anastomosis. Intraoperatively a large conglomerate was found; no Crohn’s disease changes in the mesentery were noted. Histological examination revealed a chicken bone that had perforated the cecum wall against the background of slit-like ulcers and crypt abscesses. Treatment of supposed Crohn’s disease was stopped. Control colonoscopy and biopsy showed no signs of Crohn’s disease with nine months after surgery.

Figure 1: Removed part of ileum.

c

Figure 2: Chicken bone.

c

Discussion

More than 300 cases of intestinal perforation caused by foreign bodies have been described in the literature, with fish bones, chicken bones, dentures, toothpicks and cocktail sticks being the most common objects.1 Foreign-object-related perforations are usually found at the site of sharp bend and subsequent narrowing, and the most common localities of perforation in these cases are terminal ileum and the cecum.2,3

Typically, perforation occurs with peritonitis. In rare cases, an inflammatory infiltrate is formed around the foreign body, which simulates a malignant process. Perforation of the intestine by foreign bodies is found as an exceptional case. Usually these objects pass through the gastrointestinal tract without obstruction. There are two factors that allow foreign bodies to pass freely through the gastrointestinal tract. Foreign bodies usually pass along the central axis of the intestinal lumen. In the colon, foreign objects are usually located in the centre of the faeces, which additionally protects the intestinal wall from damage. In addition to anatomical and physiological ‘obstacles’, pathological contractions are also important—for example, strictures in Crohn’s disease, fibrous strictures and exophytic or endophytic tumours of the gastrointestinal tract. Only few cases of perforation of the colon under such conditions are described in literature.4–7

According to modern concepts of Crohn’s disease and intestinal anatomy, the mesentery plays an important role in the pathogenesis and development of the disease.8 During surgery, the resection volume was selected in proportion to Crohn’s disease (resection of the affected intestine with the mesentery), which reduces the possibility of recurrence.9

Conclusion

Thus, it can be assumed that the patient has Crohn’s disease, and destructive changes in the intestinal wall (deep slit-like ulcers and stenosis of the affected intestinal wall due to oedema and inflammatory infiltration) led to perforation of the wall by a chicken bone. On the other hand, the aforementioned changes in the intestinal wall could develop against the background of perforation, since during the surgery no changes in the mesentery were found, and patient has no signs of recurrence.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

- Yury Kitsenko, Coloproctologist, Clinic of Coloproctology and Minimally Invasive Surgery, Sechenov University, Russia; Olga Tashchyan, Gastroenterologist, Department of Gastroenterology, Sechenov University, Russia; Aleksandr Pogromov, Professor, Gast

Acknowledgements

Correspondence

Yury Kitsenko, Department of Office Work, Department of Surgery ICM, St. Bolshaya Pirogovskaya, 2, bld. 4, Room 106, Sechenov University, Moscow, Russia.

Correspondence Email

yury@kitsenko.ru

Competing Interests

Nil.

  1. Akhtar S, McElvanna N, Gardiner KR, Irwin ST. Bowel perforation caused by swallowed chicken bones - a case series. Ulster Med J. 2007; 76:37–38.
  2. Rasheed AA, Deshpande V, Slanetz PJ. Colonic perforation by ingested chicken bone. Am J Roentgenol. 2001; 176:152.
  3. Mohanty AK, Flannery MT, Johnson BL, Brady PG. Clinical problem-solving. A sharp turn right. N Eng J Med. 2006; 355:500–5.
  4. Osler T, Stackhouse CL, Dietz PA, Guiney WB. Perforation of the colon by ingested chicken bone leading to diagnosis of carcinoma of the sigmoid. Dis Colon Rectum. 1985; 28:177–9.
  5. Wunsch M, Nagy GC, Merkle N. Detection of an asymptomatic sigmoid carcinoma after extramural foreign body perforation. Chirurg. 1996; 67:766.
  6. Stiefel D, Muff B, Neff U. Intestinal foreign body with sigmoid perforation in an area of carcinomatous stenosis: incidental finding or etiology. Swiss Surg. 1997; 3:100–3.
  7. Vardaki E, Maniatis V, Chrisikopoulos H, Papadopoulos A, Roussakis A, Kavadias S, Stringaris K. Sigmoid carcinoma incidentally discovered after perforation caused by an ingested chicken bone. Am J Roentgenol. 2001; 176:153–4.
  8. Coffey JC, O’Leary DP, Kiernan MG, Faul P. The mesentery in Crohn’s disease: friend or foe? Curr Opin Gastroenterol. 2016 Jul; 32(4):267–73.
  9. Coffey CJ, Kiernan MG, Sahebally SM, et al. Inclusion of the Mesentery in Ileocolic Resection for Crohn’s Disease is Associated with Reduced Surgical Recurrence. J Crohns Colitis. 2018 Nov 9; 12(10):1139–1150.

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

Diagnosis of inflammatory bowel disease is an important issue in gastroenterology. Even with use of the most modern diagnostic methods, it is not always possible to give an unequivocal answer whether the patient suffers from IBD or other intestinal damage occurs. We present a case of perforation of the cecum caused by a chicken bone under the guise of Crohn’s disease.

Case report

A 23-year-old man was admitted in February 2018 with typical clinical features of Crohn’s disease with ileocecal lesion. Colonoscopy data showed ‘knife-cut’ ulcerative defects were revealed in the ileocecal junction; biopsy revealed focal infiltration of neutrophils and deformity of crypts. Test for Cl. Difficile toxins was negative. Despite the treatment with mesalazine (4g per day), budesonide (9mg per day), azathioprine (100mg per day), remission was not achieved. In September 2018, an ileocecal abscess with a size up to 7cm was detected. Due to deterioration of the patient’s condition, we performed resection of the ileocecal junction with formation of ileotransverse anastomosis. Intraoperatively a large conglomerate was found; no Crohn’s disease changes in the mesentery were noted. Histological examination revealed a chicken bone that had perforated the cecum wall against the background of slit-like ulcers and crypt abscesses. Treatment of supposed Crohn’s disease was stopped. Control colonoscopy and biopsy showed no signs of Crohn’s disease with nine months after surgery.

Figure 1: Removed part of ileum.

c

Figure 2: Chicken bone.

c

Discussion

More than 300 cases of intestinal perforation caused by foreign bodies have been described in the literature, with fish bones, chicken bones, dentures, toothpicks and cocktail sticks being the most common objects.1 Foreign-object-related perforations are usually found at the site of sharp bend and subsequent narrowing, and the most common localities of perforation in these cases are terminal ileum and the cecum.2,3

Typically, perforation occurs with peritonitis. In rare cases, an inflammatory infiltrate is formed around the foreign body, which simulates a malignant process. Perforation of the intestine by foreign bodies is found as an exceptional case. Usually these objects pass through the gastrointestinal tract without obstruction. There are two factors that allow foreign bodies to pass freely through the gastrointestinal tract. Foreign bodies usually pass along the central axis of the intestinal lumen. In the colon, foreign objects are usually located in the centre of the faeces, which additionally protects the intestinal wall from damage. In addition to anatomical and physiological ‘obstacles’, pathological contractions are also important—for example, strictures in Crohn’s disease, fibrous strictures and exophytic or endophytic tumours of the gastrointestinal tract. Only few cases of perforation of the colon under such conditions are described in literature.4–7

According to modern concepts of Crohn’s disease and intestinal anatomy, the mesentery plays an important role in the pathogenesis and development of the disease.8 During surgery, the resection volume was selected in proportion to Crohn’s disease (resection of the affected intestine with the mesentery), which reduces the possibility of recurrence.9

Conclusion

Thus, it can be assumed that the patient has Crohn’s disease, and destructive changes in the intestinal wall (deep slit-like ulcers and stenosis of the affected intestinal wall due to oedema and inflammatory infiltration) led to perforation of the wall by a chicken bone. On the other hand, the aforementioned changes in the intestinal wall could develop against the background of perforation, since during the surgery no changes in the mesentery were found, and patient has no signs of recurrence.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

- Yury Kitsenko, Coloproctologist, Clinic of Coloproctology and Minimally Invasive Surgery, Sechenov University, Russia; Olga Tashchyan, Gastroenterologist, Department of Gastroenterology, Sechenov University, Russia; Aleksandr Pogromov, Professor, Gast

Acknowledgements

Correspondence

Yury Kitsenko, Department of Office Work, Department of Surgery ICM, St. Bolshaya Pirogovskaya, 2, bld. 4, Room 106, Sechenov University, Moscow, Russia.

Correspondence Email

yury@kitsenko.ru

Competing Interests

Nil.

  1. Akhtar S, McElvanna N, Gardiner KR, Irwin ST. Bowel perforation caused by swallowed chicken bones - a case series. Ulster Med J. 2007; 76:37–38.
  2. Rasheed AA, Deshpande V, Slanetz PJ. Colonic perforation by ingested chicken bone. Am J Roentgenol. 2001; 176:152.
  3. Mohanty AK, Flannery MT, Johnson BL, Brady PG. Clinical problem-solving. A sharp turn right. N Eng J Med. 2006; 355:500–5.
  4. Osler T, Stackhouse CL, Dietz PA, Guiney WB. Perforation of the colon by ingested chicken bone leading to diagnosis of carcinoma of the sigmoid. Dis Colon Rectum. 1985; 28:177–9.
  5. Wunsch M, Nagy GC, Merkle N. Detection of an asymptomatic sigmoid carcinoma after extramural foreign body perforation. Chirurg. 1996; 67:766.
  6. Stiefel D, Muff B, Neff U. Intestinal foreign body with sigmoid perforation in an area of carcinomatous stenosis: incidental finding or etiology. Swiss Surg. 1997; 3:100–3.
  7. Vardaki E, Maniatis V, Chrisikopoulos H, Papadopoulos A, Roussakis A, Kavadias S, Stringaris K. Sigmoid carcinoma incidentally discovered after perforation caused by an ingested chicken bone. Am J Roentgenol. 2001; 176:153–4.
  8. Coffey JC, O’Leary DP, Kiernan MG, Faul P. The mesentery in Crohn’s disease: friend or foe? Curr Opin Gastroenterol. 2016 Jul; 32(4):267–73.
  9. Coffey CJ, Kiernan MG, Sahebally SM, et al. Inclusion of the Mesentery in Ileocolic Resection for Crohn’s Disease is Associated with Reduced Surgical Recurrence. J Crohns Colitis. 2018 Nov 9; 12(10):1139–1150.

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

Diagnosis of inflammatory bowel disease is an important issue in gastroenterology. Even with use of the most modern diagnostic methods, it is not always possible to give an unequivocal answer whether the patient suffers from IBD or other intestinal damage occurs. We present a case of perforation of the cecum caused by a chicken bone under the guise of Crohn’s disease.

Case report

A 23-year-old man was admitted in February 2018 with typical clinical features of Crohn’s disease with ileocecal lesion. Colonoscopy data showed ‘knife-cut’ ulcerative defects were revealed in the ileocecal junction; biopsy revealed focal infiltration of neutrophils and deformity of crypts. Test for Cl. Difficile toxins was negative. Despite the treatment with mesalazine (4g per day), budesonide (9mg per day), azathioprine (100mg per day), remission was not achieved. In September 2018, an ileocecal abscess with a size up to 7cm was detected. Due to deterioration of the patient’s condition, we performed resection of the ileocecal junction with formation of ileotransverse anastomosis. Intraoperatively a large conglomerate was found; no Crohn’s disease changes in the mesentery were noted. Histological examination revealed a chicken bone that had perforated the cecum wall against the background of slit-like ulcers and crypt abscesses. Treatment of supposed Crohn’s disease was stopped. Control colonoscopy and biopsy showed no signs of Crohn’s disease with nine months after surgery.

Figure 1: Removed part of ileum.

c

Figure 2: Chicken bone.

c

Discussion

More than 300 cases of intestinal perforation caused by foreign bodies have been described in the literature, with fish bones, chicken bones, dentures, toothpicks and cocktail sticks being the most common objects.1 Foreign-object-related perforations are usually found at the site of sharp bend and subsequent narrowing, and the most common localities of perforation in these cases are terminal ileum and the cecum.2,3

Typically, perforation occurs with peritonitis. In rare cases, an inflammatory infiltrate is formed around the foreign body, which simulates a malignant process. Perforation of the intestine by foreign bodies is found as an exceptional case. Usually these objects pass through the gastrointestinal tract without obstruction. There are two factors that allow foreign bodies to pass freely through the gastrointestinal tract. Foreign bodies usually pass along the central axis of the intestinal lumen. In the colon, foreign objects are usually located in the centre of the faeces, which additionally protects the intestinal wall from damage. In addition to anatomical and physiological ‘obstacles’, pathological contractions are also important—for example, strictures in Crohn’s disease, fibrous strictures and exophytic or endophytic tumours of the gastrointestinal tract. Only few cases of perforation of the colon under such conditions are described in literature.4–7

According to modern concepts of Crohn’s disease and intestinal anatomy, the mesentery plays an important role in the pathogenesis and development of the disease.8 During surgery, the resection volume was selected in proportion to Crohn’s disease (resection of the affected intestine with the mesentery), which reduces the possibility of recurrence.9

Conclusion

Thus, it can be assumed that the patient has Crohn’s disease, and destructive changes in the intestinal wall (deep slit-like ulcers and stenosis of the affected intestinal wall due to oedema and inflammatory infiltration) led to perforation of the wall by a chicken bone. On the other hand, the aforementioned changes in the intestinal wall could develop against the background of perforation, since during the surgery no changes in the mesentery were found, and patient has no signs of recurrence.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

- Yury Kitsenko, Coloproctologist, Clinic of Coloproctology and Minimally Invasive Surgery, Sechenov University, Russia; Olga Tashchyan, Gastroenterologist, Department of Gastroenterology, Sechenov University, Russia; Aleksandr Pogromov, Professor, Gast

Acknowledgements

Correspondence

Yury Kitsenko, Department of Office Work, Department of Surgery ICM, St. Bolshaya Pirogovskaya, 2, bld. 4, Room 106, Sechenov University, Moscow, Russia.

Correspondence Email

yury@kitsenko.ru

Competing Interests

Nil.

  1. Akhtar S, McElvanna N, Gardiner KR, Irwin ST. Bowel perforation caused by swallowed chicken bones - a case series. Ulster Med J. 2007; 76:37–38.
  2. Rasheed AA, Deshpande V, Slanetz PJ. Colonic perforation by ingested chicken bone. Am J Roentgenol. 2001; 176:152.
  3. Mohanty AK, Flannery MT, Johnson BL, Brady PG. Clinical problem-solving. A sharp turn right. N Eng J Med. 2006; 355:500–5.
  4. Osler T, Stackhouse CL, Dietz PA, Guiney WB. Perforation of the colon by ingested chicken bone leading to diagnosis of carcinoma of the sigmoid. Dis Colon Rectum. 1985; 28:177–9.
  5. Wunsch M, Nagy GC, Merkle N. Detection of an asymptomatic sigmoid carcinoma after extramural foreign body perforation. Chirurg. 1996; 67:766.
  6. Stiefel D, Muff B, Neff U. Intestinal foreign body with sigmoid perforation in an area of carcinomatous stenosis: incidental finding or etiology. Swiss Surg. 1997; 3:100–3.
  7. Vardaki E, Maniatis V, Chrisikopoulos H, Papadopoulos A, Roussakis A, Kavadias S, Stringaris K. Sigmoid carcinoma incidentally discovered after perforation caused by an ingested chicken bone. Am J Roentgenol. 2001; 176:153–4.
  8. Coffey JC, O’Leary DP, Kiernan MG, Faul P. The mesentery in Crohn’s disease: friend or foe? Curr Opin Gastroenterol. 2016 Jul; 32(4):267–73.
  9. Coffey CJ, Kiernan MG, Sahebally SM, et al. Inclusion of the Mesentery in Ileocolic Resection for Crohn’s Disease is Associated with Reduced Surgical Recurrence. J Crohns Colitis. 2018 Nov 9; 12(10):1139–1150.

Contact diana@nzma.org.nz
for the PDF of this article

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