Learning Radiology xray montage

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 usually involves surgical resection or repair of the bowel


  • 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