Surgery for suspected appendicitis is one of the most familiar operations in emergency medicine. But case reports from Qatar, Nepal, Greece, Portugal, and now Ecuador describe a recurring surprise: the real culprit was a swallowed fish bone that had punctured a Meckel's diverticulum, a small pouch on the small intestine left over from fetal development.
The latest case, published Sept. 18 in the Journal of Surgical Case Reports, involved a 73-year-old woman in Quito who blamed her belly pain on food poisoning after a seafood meal and treated herself with over-the-counter pain relievers for four days. The Ecuadorian surgeons counted fewer than 50 English-language reports of fish bones perforating these pouches, so the injury is rare. When it does happen, it is notoriously hard to identify before surgery.
