Man with vEDS undergoes surgery after fish bone causes intestinal tear
Damage to the digestive tract can lead to serious bleeding issues
A swallowed fish bone led to an intestinal tear in a man with vascular Ehlers-Danlos syndrome (vEDS) that required delicate surgery, according to a report from Japan.
“For surgeons, an individualized surgical strategy and optimal perioperative management are important to prevent fatal complications,” researchers wrote in “Small bowel perforation caused by a fish bone in a patient with vascular Ehlers-Danlos syndrome: a case report.” It was published in the Journal of Surgical Case Reports.
EDS is a group of genetic diseases that affect the body’s connective tissues. As a result, patients experience overly flexible joints and thin skin that tears easily. In addition to these symptoms, those with vEDS also have fragile internal organs and blood vessels that are prone to rupturing or dissecting.
Gastrointestinal perforation, or tears along the digestive tract, is a recurrent condition and can lead to serious bleeding. “Surgical intervention is indicated for vEDS patients with gastrointestinal perforation; however, postoperative outcomes are poor due to severe complications arising from tissue fragility,” the researchers wrote.
Patient had a history of intestinal issues
In the report, the researchers described the case of a man in his 40s who had been diagnosed with vEDS five years prior. His medical history included a sudden rupture of the mesenteric artery, a major blood vessel supplying the intestines, and a sigmoid colon perforation, or a tear in the colon, part of the large intestine. Both issues required surgery.
The man returned to the hospital with pain in the lower right side of his abdomen. Physical examination revealed tenderness in that area, whereas blood testing revealed mild inflammation.
A CT scan with contrast dye revealed a foreign object in his small intestine, along with a tear, and some free air in the tissue attaching the intestines to the abdominal wall, known as the mesentery. After discussing his symptoms, the man recalled eating codfish six days earlier.
Gastrointestinal perforation caused by fish bones in patients with vEDS is extremely rare and requires careful assessment to determine whether conservative treatment or surgical intervention is appropriate.
Doctors concluded that a fish bone may have punctured his small intestine. Despite the risk of severe complications, emergency surgery was necessary to prevent the fish bone from damaging other organs or causing a serious inflammation in the abdomen.
During surgery, doctors found severe scarring in the small intestine. A sharp fish bone measuring about 4 cm (1.6 inches) was found about 15 cm (5.9 inches) from the end of the small intestine, piercing through the intestine and into the mesentery. The fish bone was carefully removed, and a piece of damaged intestine was cut out.
After surgery, the man developed paralytic ileus, which occurs when the muscles in the intestines temporarily stop working. This was treated with a nasogastric tube — a thin, flexible tube inserted through the nose and into the stomach to deliver food. The man was discharged from the hospital 27 days after surgery.
“Gastrointestinal perforation caused by fish bones in patients with vEDS is extremely rare and requires careful assessment to determine whether conservative treatment or surgical intervention is appropriate,” the researchers wrote. “Postoperative management is also crucial.”
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