DISCUSSIONS

Fishbone perforation is rarely seen, especially in children. Although most foreign objects can be excreted within a week of entering the gastrointestinal tract (1, 5), 1% of patients may still suffer from intestinal perforation if these fishbones were long or sharp. Moreover, it could be complicated to make a precise diagnosis because patients or their families cannot make sure what foreign object they ate in their meals. So, these cases are often misdiagnosed with acute appendicitis.
Depending on the hole’s location, patients may have various clinical symptoms, including constipation, abdominal pain, and anal pain. A study reported that 95% of patients presented with abdominal pain, which is the most crucial symptom, 81% having a fever, and 39% having local peritonitis (2). In most cases of intestinal perforation caused by a foreign object, the foreign agent is a fishbone with a pointed shape. In some countries or regions that prefer eating fish, gastric perforation or other complications caused by fishbone are very common (6). While fish bones may induce intestinal perforation in any section of the intestine, it is more commonly seen in areas of physiological stenosis or intestinal transitions such as the ileum or rectosigmoid junction (7). In a study, the probability of ileal perforation was 83%. (8). In another report, the perforation of the end of the ileum was 38.6%, but the jejunum rate was lower, just 14.3% (5).