Foreign Body Perforation
Chicken Bone

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

Treatment

• Treatment usually involves surgical resection or repair of the bowel

Complications

• Fistula formation
• Inflammatory mass

Chicken Bone Perforation of Esophagus. Above: White circle identifies a linear, radioopaque foreign body in the region of the esophagus, oriented perpendicular to the plane of the esophagus, suggesting perforation. There is increased prevertebral soft tissue in this region. Below: An axial CT scan through the neck demonstrates the foreign body (blue circle) extending outside and to the right of the expected location of the esophagus.
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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/01/1761–15