the ingestion of foreign bodies ( fb ) is a common problem worldwide and affects all ages , however it is particularly important in the pediatric population and in mentally impaired adults , .
commonly ingested fb include medication packaging , dentures , coins and fish and chicken bones , amongst others .
the typical outcome of fb ingestion is good , with approximately 80% of ingested material passed spontaneously through the gastrointestinal tract without requiring any invasive medical intervention , 20% of patients requiring an endoscopic removal , and just 1% of ingested material will cause perforation requiring surgical treatment , , .
it is important to mention that serious complications can occur due to ingested fb , such as ; obstruction , ulcer formation , gastrointestinal ( gi ) bleeding , gi perforation , tracheoesophageal fistula formation and bacteremia , amongst others , , , , , .
when this fb become impacted , they often do so at sites of physiologic narrowing , such as the pharynx , upper and lower esophageal sphincter , stomach , duodenum and ileum .
the most usual site is the ileum and the most common complication is an intra - abdominal abscess .
we present a case of extraluminal migration to the spleen generating splenic rupture and hemoperitoneum which presented as acute abdominal pain .
a 59-year - old man was admitted to the emergency room(er ) with a severe sharp abdominal pain of 8  h of duration .
the pain had an insidious onset , was localized on the left upper and lower quadrant , was exacerbated with breathing movements and was associated with dyspnea .
vital signs were : temperature 37.4  c ; blood pressure 84/53  mmhg ; heart rate 108 beats / min ; and respiratory rate 25 breaths / min .
the initial physical examination revealed normal breathing sounds and regular heart beat without any murmur .
he had normal bowel sounds , tenderness on the upper and lower left quadrant and muscle guarding without rebound pain .
serum laboratory examinations showed : a white blood cell count of 10,760  mm , neutrophils of 79% , lymphocytes of 10.2% , hemoglobin 11.5  g / dl and a platelet count of 259.000/l .
serum biochemistry tests revealed bun of 12  mg / dl , creatinine 1.12  mg / dl , c - reactive protein of 8.8  mg / dl , and lactate of 1.8  mmol / l .
arterial blood gases showed ph : 7.4 , pco2 : 27.6  mmhg , po2 : 99.7  mmhg , hco3 : 19.7 , be : 3.3 , which were compatible with acute respiratory alkalosis .
after primary er medical treatment he was evaluated by general surgery and an abdominal and chest contrasted ct scan was ordered , which reported a splenic rupture associated with the presence of a linear fb of 3.0  cm , focal inflammatory changes and intrasplenic collection ( fig .
written and informed consent was obtained and , an exploratory laparotomy was therefore performed to resolve his acute abdominal pain due to the high risk of peritonitis ( fig .
an enlarged spleen was found during the surgery , with a traumatic rupture of 80% of its capsule in the posterior area due to a fishbone of 3    0.1    0.1  cm . the patient had a 500cc hemoperitoneum and a left subphrenic hematoma .
splenectomy was performed , the hemoperitoneum was drained and the fishbone was recovered ( fig .
3 ) . the patient presented remission of the abdominal pain and was discharged 3 days later without any complications .
follow - up at 18 days later was unremarkable , during which a pneumococcal polysaccharide vaccine was administered .
perforations of gi secondary to the ingestion of a fb can occur , however , and those requiring surgery correspond to less than 1% of cases , , . as the reported case notes , perforation of the gi by a fishbone and its extraluminal
sharp fb , such as fish bones , chicken bones and needles , are more prone to migrate outside the lumen if they are not removed early , causing perforation of the gastrointestinal tract and dangerous complications .
patients usually do not remember the time of ingestion of the fb , which is compatible with our reported case .
a diagnosis of acute abdominal pain is challenging and requires diagnostic images to help elucidate the source of the pain .
one of these diagnostic images is an abdominal radiograph which has low sensibility ( 32% ) : even if fish bones have enough calcium to be radiopaque , they can be overshadowed by soft tissues , .
the first diagnostic method that should be used , therefore , is a ct scan , because it has a sensitivity of 71.4% and was useful as shown in this case report , . we found , in the literature , that the usual presentation of fb perforation in the gi tract appears with symptoms of peritonitis , thickened gi , free intraperitoneal air that appears in the ct , and adhesions found via a laparotomy or laparoscopy .
the most common migratory destination for fish bones is to neck structures , , and very few of them migrate to the abdomen ( such as the peritoneal cavity , liver or bladder ) , .
nevertheless , this patient had a rare case of fishbone migration that probably perforated the colon through the splenic flexure and then migrated to the spleen , causing an encapsulated splenic hematoma , which subsequently led to a rupture of the splenic capsule , causing the acute abdominal pain that the patient presented .
this acute abdominal pain , caused by a fishbone , is an unusual case , which , at the time of the diagnosis , required diagnostic images , such as a ct scan , and an experienced radiologist to interpret the results of the ct scan .
the learning point is that fb that are suspected to have migrated extraluminally should be considered for removal by surgical procedure , without delay , in order to prevent traumatic complications such as the one described .
this article adds to the literature that fb ingestion and extraluminal migration can be associated with splenic rupture , a previously unknown complication .
fb ingestion is a relatively benign condition , however some serious complications can arise , albeit infrequently .
the patient reported here is the first one in the literature to present a splenic rupture due to the extraluminal migration of an ingested fish bone through the splenic flexure of the colon .
fb that are suspected to migrate extraluminally should be considered for promptly removal by surgical procedure in order to prevent traumatic complications .
written informed consent was obtained from the patient for the publication of this article and accompanying images .
 highlightsforeign body ingestion is a relatively common and benign condition ; some serious complications , however , can arise.approximately 1% of all ingested fb will cause perforation requiring surgical treatment.sharp fb , such as fish bones , chicken bones and needles , are more prone to migrate outside the gastrointestinal lumen if they are not removed early.the patient reported here is the first one in the literature to present a splenic rupture due to extra - luminal migration of an ingested fish bone through the splenic flexure of the colon . 
Introduction
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Discussion
Conclusion
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