{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T08:59:35Z","timestamp":1785142775791,"version":"3.55.0"},"reference-count":14,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"abstract":"<jats:p>\n                    Fish bone perforation of the gastrointestinal tract is rare and frequently misdiagnosed\u2014not because it is inherently difficult to recognize, but because it is not considered. Symptoms are nonspecific, patients may not recall ingestion, and the condition can mimic acute abdomen. We performed a systematic review of published case reports and case series with individual patient-level data extraction; 220 patients from 199 publications were included. The small bowel, including Meckel\u2019s diverticulum, was the most frequent perforation site (46.3%), followed by the colorectum (22.9%) and upper gastrointestinal tract (20.4%). Contained perforation was most common (48.1%); free perforation occurred in 22.8%. Initial misdiagnosis occurred in 38.1% and decreased over time (OR 0.54; 95% CI: 0.40-0.71;\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    &lt; .001). Absence of recalled ingestion was not independently associated with misdiagnosis, suggesting that nonspecific symptoms and inflammatory mimicry play a larger role than history alone. CT identified the fish bone in 78.5% of patients who underwent CT, with increasing yield over time. Abscess predicted surgery (OR 4.07; 95% CI: 1.35-13.2;\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    = .014). Surgery was used in 86.2%. No severe outcomes occurred among 20 patients treated with endoscopy alone. The accompanying case extends these findings to the postoperative setting: CT identified the foreign body and guided the decision to avoid reoperation, with endoscopic removal as definitive treatment. Fish bone perforation should be considered in any patient with unexplained localized intra-abdominal inflammation, regardless of ingestion history. CT is the diagnostic cornerstone, and endoscopic treatment is feasible in selected stable patients with contained injury.\n                  <\/jats:p>","DOI":"10.1177\/00031348261471479","type":"journal-article","created":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T02:24:02Z","timestamp":1784946242000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["CT Changed the Diagnosis: Temporal Trends in Recognition and Management of Fish Bone\u2013Induced Gastrointestinal Perforation"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7680-5911","authenticated-orcid":false,"given":"Dmitrii","family":"Semenov","sequence":"first","affiliation":[{"name":"Department of Surgery, K+31 Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denis","family":"Seleznev","sequence":"additional","affiliation":[{"name":"Department of Surgery, K+31 Clinic"},{"name":"Pirogov Russian National Research Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oleg","family":"Yudin","sequence":"additional","affiliation":[{"name":"Department of Surgery, K+31 Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirill","family":"Bolikhov","sequence":"additional","affiliation":[{"name":"Department of Surgery, K+31 Clinic"},{"name":"Pirogov Russian National Research Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arsen","family":"Rasulov","sequence":"additional","affiliation":[{"name":"Mother and Child Group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexey","family":"Chzhao","sequence":"additional","affiliation":[{"name":"Department of Surgery, K+31 Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,24]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.05.0178"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2025.1607262"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.5152\/dir.2015.15187"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2010.11.010"},{"key":"e_1_3_6_6_2","first-page":"8887603","article-title":"Fish bone causing perforation of the intestine and Meckel\u2019s diverticulum","volume":"2020","author":"Shahid F","year":"2020","unstructured":"Shahid F, Abdalla SO, Elbakary T, Elfaki A, Ali SM. Fish bone causing perforation of the intestine and Meckel\u2019s diverticulum. Case Rep Surg. 2020;2020:8887603.","journal-title":"Case Rep Surg"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-004-2430-1"},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/MS9.0000000000003288"},{"key":"e_1_3_6_9_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0042-100456"},{"key":"e_1_3_6_10_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13017-025-00611-9"},{"issue":"3","key":"e_1_3_6_11_2","first-page":"E82","article-title":"Endoscopic treatment of a sigmoid perforation caused by an ingested fish bone","volume":"49","author":"Fang C","year":"2017","unstructured":"Fang C, Ye L, Mao X, Zhang J. Endoscopic treatment of a sigmoid perforation caused by an ingested fish bone. Endoscopy. 2017;49(3):E82-E83.","journal-title":"Endoscopy"},{"key":"e_1_3_6_12_2","doi-asserted-by":"publisher","DOI":"10.1086\/649554"},{"key":"e_1_3_6_13_2","doi-asserted-by":"publisher","DOI":"10.9738\/INTSURG-D-14-00163.1"},{"key":"e_1_3_6_14_2","doi-asserted-by":"publisher","DOI":"10.1177\/0846537119899198"},{"key":"e_1_3_6_15_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10140-020-01800-6"}],"container-title":["The American Surgeon\u2122"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348261471479","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00031348261471479","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348261471479","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T08:02:24Z","timestamp":1785139344000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00031348261471479"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,24]]},"references-count":14,"alternative-id":["10.1177\/00031348261471479"],"URL":"https:\/\/doi.org\/10.1177\/00031348261471479","relation":{},"ISSN":["0003-1348","1555-9823"],"issn-type":[{"value":"0003-1348","type":"print"},{"value":"1555-9823","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,24]]},"article-number":"00031348261471479"}}