Foreign Body (Chicken Bone) Perforation of Bowel

General Considerations

• Overall, most ingested foreign bodies occur in children
• Perforation occurs in less than 1% of ingested foreign bodies
• Known agents include chicken and fish bones, toothpicks, dentures and cocktail sticks
• Blunt foreign bodies may also perforate through a slower process of pressure necrosis of the bowel wall
• Most patients don’t remember ingesting the foreign body
• At greater risk are:
• The elderly
• Those wearing dentures
• Patients with bowel strictures
• Alcoholics and psychiatric patients

Clinical Findings

• Pain
• Nausea
• Vomiting
• Fever

Imaging Findings

• CT is most useful in finding the foreign body and the reaction to them
• Most common site of perforation is terminal ileum (83%) and colon
• Visualization of the foreign body outside of the bowel lumen
• Thickening of the bowel wall
• Surrounding inflammatory reaction
• Small amounts of loculated extraluminal air
• Free air is not common

Differential Diagnosis

• Appendicitis
• Diverticulitis

Treatment

• Treatment usually involves surgical resection or repair of the bowel

Complications

• Fistula formation
• Inflammatory mass
• Acute abdomen

Chicken Bone Perforation of Cecum. The patient had ingested chicken about a week prior. There is a calcific, curvilinear foreign body (yellow arrow) outside of the lumen with adjacent bowel wall thickening, stranding and a small amount of extra-luminal air (white arrow). The 3D color reconstruction shows the chicken bone (oval) outside of the cecum.
For these same photos without the arrows, click here and here
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Ulster Med J. 2007 January; 76(1): 37–38.  Bowel perforation caused by swallowed chicken bones – a case series.  S Akhtar, N McElvanna, KR Gardiner, and ST Irwin

Amjad A. Rasheed, Vikram Deshpande, Priscilla J. Slanetz. Colonic Perforation by Ingested Chicken Bone. AJR:176, January 2001;176:152 0361–803X/01/1761–152