Intestinal Perforation After the Incidental Ingestion of a Fishhook

The vast majority (75%) of ingested foreign bodies pass through the gastrointestinal tract spontaneously and require no surgical intervention. Indeed, the emergency department (ED) management of ingested foreign bodies is largely based on the age of the patient and the time elapsed since ingestion, as well as the physical characteristics of the foreign body. We present this case to emphasize the importance of radiologic imaging studies in the ED management of adults with an acute abdomen of unknown etiology. A 44-year-old woman presented to the ED with right upper quadrant pain of 2 days duration. There was evidence of localized peritoneal irritation on physical examination. A radio-opaque fishhook-shaped object was visualized on the plain abdominal film. Helical computed tomography demonstrated a metallic object in the small bowel with extension through the thickened and inflamed intestinal wall. The patient did not report known ingestion of a foreign body. At exploratory laparotomy, a fishhook was recovered despite the patient's unawareness of having ingested a foreign body. The ED management of an otherwise healthy adult with an acute abdomen was facilitated with plain film radiography and abdominal computed tomography.