Large Chicken Bone Impacted in Colonic Diverticulum Mimicking Diverticulitis : ACG Case Reports Journal

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Large Chicken Bone Impacted in Colonic Diverticulum Mimicking Diverticulitis

Stoskute, Monika BS1; Pajot, Gregory MD1; Shuja, Asim MD1

Author Information
ACG Case Reports Journal: November 2022 - Volume 9 - Issue 11 - p e00917
doi: 10.14309/crj.0000000000000917
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CASE REPORT

A 71-year-old woman with a history of diverticulosis presented to the emergency department with left lower quadrant pain for 2 days rated 10 of 10. She had a fever of 38.1°C and a leukocytosis of 12.8 k/mm3. A computed tomography scan revealed sigmoid diverticula, focal wall thickening, fat stranding, and a linear hyperdensity in the sigmoid colon (Figure 1). She was started on antibiotics and admitted for the management of diverticulitis and pain. Concern for a possible foreign body evidenced by the linear hyperdensity drove the decision to proceed with colonoscopy. On colonoscopy, a chicken bone was found impacted in a sigmoid colon diverticulum with surrounding inflammation (Figures 2 and 3). It was successfully removed with a rat tooth forceps without complications or subsequent signs of mucosal perforation (Figure 4). Her symptoms improved, and she was discharged with oral antibiotics. She did not recall ingesting the bone.

F1
Figure 1.:
Axial computed tomography scan showing hyperdense lesion in the sigmoid colon.
F2
Figure 2.:
Colonoscopy image showing a chicken bone in the sigmoid colon.
F3
Figure 3.:
Colonoscopy image showing the chicken bone in the diverticulum.
F4
Figure 4.:
The removed intact chicken bone measuring 5 cm.

Acute diverticulitis is normally a contraindication to colonoscopy because of risk of perforation.1 However, in this instance when the precipitant of inflammation is a foreign body, a colonoscopy can be cautiously attempted for removal.

Ingested foreign bodies more commonly become affected in the proximal gastrointestinal tract where the lumen is narrower.2,3 However, in this case of severe diverticulosis, the foreign body became impacted in the sigmoid colon.

DISCLOSURES

Author contributions: M. Stoskute wrote the original draft of the manuscript. G. Pajot and A. Shuja wrote, reviewed, and edited the manuscript. A. Shuja is the article guarantor.

Financial disclosure: None to report.

Informed consent was obtained for this case report.

REFERENCES

1. Crispin A, Birkner B, Munte A, Nusko G, Mansmann U. Process quality and incidence of acute complications in a series of more than 230,000 outpatient colonoscopies. Endoscopy. 2009;41(12):1018–25.
2. Goh BK, Chow PK, Quah HM, et al. Perforation of the gastrointestinal tract secondary to ingestion of foreign bodies. World J Surg. 2006;30(3):372–7.
3. Velitchkov NG, Grigorov GI, Losanoff JE, Kjossev KT. Ingested foreign bodies of the gastrointestinal tract: Retrospective analysis of 542 cases. World J Surg. 1996;20(8):1001–5.
© 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.