S1975 Chicken Ticca: Hard Object, Wrong Hole

Introduction: Diverticular disease is a common, largely age dependent condition that occurs due to herniation of the mucosa and submucosa through the muscularis propria often at levels of vasa recta penetration. This condition is typically asymptomatic with approximately 4% of patients developing diverticulitis. Fewer than 20% may exhibit symptoms of rectal bleeding, abdominal pain, abscess, perforation or peritonitis. Risk factors include obesity, smoking, and low-fiber diet. Rarely, diverticulitis is caused by ingestion of foreign body (IFB). Unlike typical scenarios of diverticulitis, endoluminal examination and intervention in cases of IFB may be paramount. Case Description/Methods: The patient is a 58 year old female presenting with left lower quadrant abdominal pain as well as vomiting, diarrhea and fever for one day. Upon presentation, the patient had a leukocytosis (WBC 20.3) with associated tenderness. A Computed Tomography (CT) scan revealed pericolonic inflammatory changes of the sigmoid colon including a tubular 50 x 3mm structure suspicious for a foreign body (Figure). Given the clinical picture, Piperacillin/Tazobactam was initiated and a sigmoidoscopy was performed. Upon endoscopy, a chicken wing bone was visualized within a diverticulum and removed successfully utilizing a 10mm snare. The patient’s WBC normalized and her symptoms improved. Subsequently, she tolerated a diet and was discharged on Ciprofloxacin/Metronidazole for 1-week course. Discussion: Diverticulitis unrelated to IFB has been theorized to occur either due to overgrowth of intestinal flora within a diverticulum or due to localized immune dysregulation. IFB mostly occurs in the elderly, those with psychiatric disorder as well as those with alcohol abuse. Most causative foods (chicken bones, fish bones, etc.) pass without issue. That said there are cases of complications such as colonic perforation, diverticulitis as well as abscesses occurring due to IFB. Utilization of cross-sectional imaging offers diagnostic utility for the radiopaque IFB. The findings of diverticulitis plus a foreign body should be of concern as complications may occur. Typically, in cases of acute diverticulitis, endoscopy is not performed due to operative risk in the setting of active inflammation. In this scenario, early endoluminal intervention and successful foreign object extraction was key to the patients positive clinical outcome and likely prevented further potential complications.Figure 1.: Chicken Bone Within a Diverticulum.