Intestinal perforation due to fish bone diagnosed preoperati
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A 73-year-old female was presented to emergency department with a one-day history of increasing lower abdominal pain. The patient had attended a wedding party of her grandson and ate baked red snapper. Her past medical history was unremarkable and she was taking medication for hypertension. Her vital signs included blood pressure 119/66 mmHg, pulse rate 80 beats/min, and body temperature 36.2°C. On examination, the patient had a slightly distended abdomen with significant right iliac fossa guarding and tenderness. Her white cell count and C-reactive protein levels were 11900/mm3 and 1.24 mg/dL, respectively, indicating systemic inflammation. Abdominal computed tomography demonstrated pneumoperitoneum and fluid within the abdominal cavity, as well as dilated intestine, suggesting diffuse peritonitis due to alimentary tract perforation. Under general anesthesia, the patient underwent diagnostic/therapeutic laparoscopy, which showed acutely inflamed ileum and purulent ascites.

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