Surgically treated purulent pericarditis induced by ingested fish bone: a case report

Background: Aspiration of fish bones is common, but perforation of the gastrointestinal tract is very rare. Once perforation occurs, fatal complications such as mediastinitis and cardiac tamponade can occur. Here, we present a case of acute pericarditis due to perforation of a fish bone.

Case presentation: A 66-year-old woman was referred to our hospital with shortness of breath. Blood tests showed high C-reactive protein, and contrast-enhanced computed tomography showed a large amount of pericardial fluid as well as a foreign body with high bone density in the pericardial sac. Upper gastrointestinal endoscopy showed no evidence of penetration of the esophageal or gastric mucosa. Emergency open chest surgery was performed, and the pericardial sac was filled with copious amounts of pus. The fish bone-like foreign body was found to penetrate the pericardial membrane from the diaphragmatic side. The foreign body was removed, a drainage tube was placed, and the chest was closed. After 2 weeks of postoperative antibiotics, the patient was discharged from the hospital in stable general condition. Three months after the surgery, the patient had no recurrence of pericarditis.

Conclusions: We reported a rare case of gastrointestinal perforation by a fish bone, resulting in pericardium, which was treated by surgical drainage.