Fishbone impaction with cecal perforation mimicking acute appendicitis: A case report

Introduction: Right lower quadrant pain is a usual presentation of many acute abdominal condi-tions. However, it could as well be the presentation of unusual conditions. To date, cecal perfora-tion as a result of fish bone impaction has not been reported in pediatric patients.Case description: A 10-year-old Chinese girl presented with right sided abdominal pain and fever. Abdominal examination revealed tenderness and guarding in the right iliac fossa. She was ini-tially thought to have acute appendicitis. Ultrasound of the abdomen was not conclusive. A com-puted tomography of the abdomen with contrast revealed that the appendix was not dilated. It also showed a faint 1.3-cm-long linear hyper-density in the cecum, with peritoneal thickening at the right iliac fossa. Laparoscopy confirmed a fish bone impaction causing cecal perforation. The fish bone was retrieved, and the cecal perforation repaired through a McBurney incision. She was discharged 3 days after operation.Conclusion: Although rare, it is important to consider the possibility of an intestinal perforation caused by swallowed foreign objects such as fish bone in children presenting with acute abdomi-nal pain.