{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T09:17:26Z","timestamp":1765963046550,"version":"3.48.0"},"reference-count":56,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T00:00:00Z","timestamp":1764288000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Background and Clinical Significance: Ingestion of foreign bodies may lead to perforation of the gastrointestinal tract in its various segments. This may be accompanied by infections of the mediastinum after esophageal perforations and peritonitis after perforations of the stomach and bowel. Case Presentation: A 64-year-old man was admitted to the hospital because of abdominal pain and fever. The laboratory testing showed increased indices of inflammation. A CT scan of the abdomen revealed perforation of the stomach pylorus wall from a foreign body. Additionally, there were imaging findings suggesting concealed peritonitis in the adjacent area of stomach perforation. A 3.9 cm foreign body was removed with gastroscopy. The investigation into the nature of the foreign body suggested that it was a fish otolith (a structure composed of calcium carbonate, also known as an ear bone). The patient adhered to a Mediterranean diet. He recalled ingesting parts of the head of a 2.5 kg sea bream about 40 days before his admission to the hospital. The patient received broad-spectrum antimicrobial treatment, specifically intravenous ampicillin\/sulbactam (2 g\/1 g) every 8 h. He had complete resolution of his infection, with full resolution of symptoms and normalization of all abnormal signs noted in the physical examination at outpatient follow-up. Conclusions: Ingestion of a fish otolith may lead to perforation of the gastrointestinal tract and subsequent intra-abdominal infection. Prompt diagnosis with abdominal imaging, especially a CT scan, removal of the foreign body by upper gastrointestinal endoscopy (if possible), and broad-spectrum antibiotics are necessary for the successful management of such cases.<\/jats:p>","DOI":"10.3390\/reports8040252","type":"journal-article","created":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T08:26:57Z","timestamp":1764318417000},"page":"252","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Concealed Peritonitis Due to Stomach Perforation from a Fish Otolith: A Case Report"],"prefix":"10.3390","volume":"8","author":[{"given":"Matthew E.","family":"Falagas","sequence":"first","affiliation":[{"name":"Alfa Institute of Biomedical Sciences (AIBS), 151 23 Marousi, Athens, Greece"},{"name":"School of Medicine, European University Cyprus, 2404 Nicosia, Cyprus"},{"name":"Department of Medicine, Tufts University School of Medicine, Boston, MA 02111, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura T.","family":"Romanos","sequence":"additional","affiliation":[{"name":"Alfa Institute of Biomedical Sciences (AIBS), 151 23 Marousi, Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annabel","family":"Hopkins","sequence":"additional","affiliation":[{"name":"Department of Imaging, Hygeia Hospital, 151 23 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Athanasios","family":"Sioulas","sequence":"additional","affiliation":[{"name":"Department of Medicine, Hygeia Hospital, 151 23 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Tsitskari","sequence":"additional","affiliation":[{"name":"School of Medicine, European University Cyprus, 2404 Nicosia, Cyprus"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,28]]},"reference":[{"key":"ref_1","first-page":"e81060","article-title":"Emergency Laparoscopic Removal of an Ingested Fishbone Perforating the Stomach After Endoscopy: A Case Report","volume":"17","author":"Tomono","year":"2025","journal-title":"Cureus"},{"key":"ref_2","first-page":"4348787","article-title":"Double Magnet Ingestion Causing Intestinal Perforation with Peritonitis: Case Report and Review of the Literature","volume":"2022","author":"Abuzneid","year":"2022","journal-title":"Case Rep. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"384","DOI":"10.12998\/wjcc.v6.i10.384","article-title":"Rectal Perforation by Inadvertent Ingestion of a Blister Pack: A Case Report and Review of Literature","volume":"6","author":"Fleres","year":"2018","journal-title":"World J. Clin. Cases"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.jemermed.2012.03.025","article-title":"Prevalence, Clinical Features and Management of Pediatric Magnetic Foreign Body Ingestions","volume":"44","author":"Tavarez","year":"2013","journal-title":"J. Emerg. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1007\/BF00186363","article-title":"Perforation of the Cecum by a Toothpick. Case Report and Review of the Literature","volume":"379","author":"Hauser","year":"1994","journal-title":"Langenbecks Arch. Chir."},{"key":"ref_6","first-page":"181","article-title":"Perforation of the Sigmoid Colon by Swallowed Chicken Bone: Case Reports and Review of Literature","volume":"66","author":"Singh","year":"1981","journal-title":"Int. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2050313X251366363","DOI":"10.1177\/2050313X251366363","article-title":"Esophageal Perforation with Mediastinitis Leading to Mycotic Aortic Pseudoaneurysm in a Pediatric Patient: A Complication of Sharp Foreign Body Ingestion","volume":"13","author":"AlAbdullah","year":"2025","journal-title":"SAGE Open Med. Case Rep."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"4136","DOI":"10.21037\/jtd-2025-758","article-title":"Esophageal Foreign Bodies: A Retrospective Analysis of 275 Cases","volume":"17","author":"Liu","year":"2025","journal-title":"J. Thorac. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1136\/archdischild-2025-328576","article-title":"Oesophageal Impaction of Button Batteries in Children: A Tertiary Centre Experience","volume":"110","author":"Letrillart","year":"2025","journal-title":"Arch. Dis. Child."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Yang, Q., Liu, H., Shu, X., and Liu, X. (2022). Risk Factors for the Poor Prognosis of Benign Esophageal Perforation: 8-Year Experience. BMC Gastroenterol., 22.","DOI":"10.1186\/s12876-022-02624-z"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"638","DOI":"10.3348\/kjr.2025.0118","article-title":"Foreign Body Ingestion: Radiologic Evaluation, Findings, and Management","volume":"26","author":"Lee","year":"2025","journal-title":"Korean J. Radiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"rjae787","DOI":"10.1093\/jscr\/rjae787","article-title":"Fishbone Perforation of the Stomach into the Lesser Sac and Pancreas with Abscess, a Fishy Business","volume":"2024","author":"Arcia","year":"2024","journal-title":"J. Surg. Case Rep."},{"key":"ref_13","first-page":"52","article-title":"Gastric Perforation Secondary to Prolonged Multiple Foreign Body Ingestions in a Patient with Schizophrenia","volume":"26","author":"Abboud","year":"2024","journal-title":"Isr. Med. Assoc. J. IMAJ"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1659","DOI":"10.1007\/s00414-024-03188-1","article-title":"Fatal Bowel Perforation Caused by Ingestion of High-Powered Magnets in a 6-Year-Old Boy","volume":"138","author":"Peyron","year":"2024","journal-title":"Int. J. Legal Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"5205","DOI":"10.1097\/MS9.0000000000003288","article-title":"Bowel Perforation Caused by Foreign Body Ingestion Presenting as Intestinal Obstruction: A Case Report Highlighting the Importance of Early Diagnosis","volume":"87","author":"Xu","year":"2025","journal-title":"Ann. Med. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"111062","DOI":"10.1016\/j.ijscr.2025.111062","article-title":"A Case Report of a Sigmoid Perforation within an Inguinoscrotal Hernia Sac Caused by Ingestion of a Chicken Wishbone","volume":"128","author":"Claassens","year":"2025","journal-title":"Int. J. Surg. Case Rep."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1007\/s12328-025-02101-6","article-title":"Ascending Colon Perforation by a Migrated Pancreatic Spontaneous Dislodgment Stent: A Case Report","volume":"18","author":"Okumura","year":"2025","journal-title":"Clin. J. Gastroenterol."},{"key":"ref_18","first-page":"e72099","article-title":"Fishbone Foreign Body Ingestion with Gastric Impaction and Intestinal Micro-Perforation in an Adult Female: A Case Report","volume":"16","author":"Dupont","year":"2024","journal-title":"Cureus"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"110401","DOI":"10.1016\/j.ijscr.2024.110401","article-title":"Not Your Typical Abdominal Pain: Case Report of a Fisherman Presenting to the Trauma & Emergency Surgery Department with Intestinal Perforation Due to an Eel Fish","volume":"124","author":"Mokbul","year":"2024","journal-title":"Int. J. Surg. Case Rep."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"110284","DOI":"10.1016\/j.ijscr.2024.110284","article-title":"Ileal Perforation Peritonitis Secondary to Accidental Ingestion of a Chicken Bone: A Case Report","volume":"123","author":"Panday","year":"2024","journal-title":"Int. J. Surg. Case Rep."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3548","DOI":"10.12998\/wjcc.v12.i18.3548","article-title":"Colon Perforation with Severe Peritonitis Caused by Erotic Toy Insertion and Treated Using Vacuum-Assisted Closure: A Case Report","volume":"12","author":"Lin","year":"2024","journal-title":"World J. Clin. Cases"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"109915","DOI":"10.1016\/j.ijscr.2024.109915","article-title":"Ileal Perforation Peritonitis Secondary to Ingestion of Magnetic Beads in the Older Child: A Case Report","volume":"121","author":"Ndoye","year":"2024","journal-title":"Int. J. Surg. Case Rep."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"107216","DOI":"10.1016\/j.ijscr.2022.107216","article-title":"Gastrointestinal Perforations by Ingested Foreign Bodies: A Preoperative Diagnostic Flowchart-Based Experience. A Case Series Report","volume":"95","author":"Mejri","year":"2022","journal-title":"Int. J. Surg. Case Rep."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1097\/TA.0000000000001265","article-title":"This Too Shall Pass: A Study of Ingested Sharp Foreign Bodies","volume":"82","author":"Zamary","year":"2017","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5223\/pghn.2023.26.1.1","article-title":"Management of Gastrointestinal Foreign Bodies with Brief Review of the Guidelines","volume":"26","author":"Demiroren","year":"2023","journal-title":"Pediatr. Gastroenterol. Hepatol. Nutr."},{"key":"ref_26","first-page":"e6971","article-title":"Upper Gastrointestinal Bleeding Secondary to an Incidental, Impacted Foreign Body in the Duodenum","volume":"12","author":"Odeghe","year":"2020","journal-title":"Cureus"},{"key":"ref_27","first-page":"869","article-title":"Swallowed Foreign Bodies in Adults","volume":"109","author":"Ambe","year":"2012","journal-title":"Dtsch. Arzteblatt Int."},{"key":"ref_28","first-page":"e44","article-title":"A Rare Case of Gastrointestinal Tract Foreign Body; Glassy Stomach","volume":"5","author":"Ebrahimi","year":"2017","journal-title":"Emerg. Tehran Iran"},{"key":"ref_29","first-page":"296","article-title":"Fish Bone Perforation Mimicking Acute Appendicitis","volume":"2","author":"Almoudaris","year":"2011","journal-title":"J. Med. Cases"},{"key":"ref_30","first-page":"100044","article-title":"Ingestion of a Saw-Edge Knife in a Patient with Mental Illness: A Unique and Uncommon Presentation","volume":"2","author":"Gopinath","year":"2023","journal-title":"JEM Rep."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"P\u00eervulescu, I.C., Najm, A., Popa, E.C., Chiotoroiu, A.L., Cretoiu, S.M., and Gaspar, B.S. (2023). A Unique Case of Foreign Body Acquired by Stabbing and Retained for 7 Years in the Sigmoid Colon. Reports, 6.","DOI":"10.3390\/reports6020024"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"29","DOI":"10.5455\/2349-2902.isj20140510","article-title":"7\u201d Long Knife for 7 Years in the Duodenum: A Rare Case Report and Review of Literature","volume":"1","author":"Bhasin","year":"2014","journal-title":"Int. Surg. J."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Li, C., Yong, C.-C., and Encarnacion, D.D. (2019). Duodenal Perforation Nine Months after Accidental Foreign Body Ingestion, a Case Report. BMC Surg., 19.","DOI":"10.1186\/s12893-019-0594-5"},{"key":"ref_34","first-page":"e85867","article-title":"Perforation of the Large Intestine by a Fish Bone Mimicking Cancer: A Rare Case Report","volume":"17","year":"2025","journal-title":"Cureus"},{"key":"ref_35","first-page":"38","article-title":"Age and Growth Studies of the Sphyraenidae Family in the Southeastern Mediterranean Based on Otolith Measurements","volume":"37","author":"Wadie","year":"1989","journal-title":"Folia Morphol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.1111\/jfb.70098","article-title":"Age Determination, Growth and Otolith Shape Analysis of Lepidotrigla Cavillone from Sardinian and Sicilian Waters (Mediterranean Sea)","volume":"107","author":"Bellodi","year":"2025","journal-title":"J. Fish Biol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"421","DOI":"10.5694\/mja2.50276","article-title":"The Management of Diverticulitis: A Review of the Guidelines","volume":"211","author":"You","year":"2019","journal-title":"Med. J. Aust."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Haddad, N., Kanj, S.S., Awad, L.S., Abdallah, D.I., and Moghnieh, R.A. (2019). The 2018 Lebanese Society of Infectious Diseases and Clinical Microbiology Guidelines for the Use of Antimicrobial Therapy in Complicated Intra-Abdominal Infections in the Era of Antimicrobial Resistance. BMC Infect. Dis., 19.","DOI":"10.1186\/s12879-019-3829-2"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1089\/sur.2018.120","article-title":"Clinical Practice Guidelines in Complicated Intra-Abdominal Infection 2018: An Indonesian Perspective","volume":"20","author":"Lalisang","year":"2019","journal-title":"Surg. Infect."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1089\/sur.2016.261","article-title":"The Surgical Infection Society Revised Guidelines on the Management of Intra-Abdominal Infection","volume":"18","author":"Mazuski","year":"2017","journal-title":"Surg. Infect."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1007\/BF01690508","article-title":"Risk Factors Leading to Clinical Failure in the Treatment of Intra-Abdominal or Skin\/Soft Tissue Infections","volume":"15","author":"Falagas","year":"1996","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis. Off. Publ. Eur. Soc. Clin. Microbiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"zrae165","DOI":"10.1093\/bjsopen\/zrae165","article-title":"Swedish National Guidelines for Diagnosis and Management of Acute Appendicitis in Adults and Children","volume":"9","author":"Tiselius","year":"2025","journal-title":"BJS Open"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1089\/sur.2024.137","article-title":"The Surgical Infection Society Guidelines on the Management of Intra-Abdominal Infection: 2024 Update","volume":"25","author":"Huston","year":"2024","journal-title":"Surg. Infect."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1111\/j.1365-2036.2006.03154.x","article-title":"Systematic Review: Fluoroquinolones for the Treatment of Intra-Abdominal Surgical Infections","volume":"25","author":"Falagas","year":"2007","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"812","DOI":"10.3947\/ic.2022.0156","article-title":"Korean Society of Infectious Diseases Korean Guidelines for Use of Antibiotics for Intra-Abdominal Infections in Adults","volume":"54","author":"Yoon","year":"2022","journal-title":"Infect. Chemother."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1016\/j.ijantimicag.2019.01.004","article-title":"Fluoroquinolone-Based versus \u03b2-Lactam-Based Regimens for Complicated Intra-Abdominal Infections: A Meta-Analysis of Randomised Controlled Trials","volume":"53","author":"Mavros","year":"2019","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1016\/j.jviscsurg.2020.11.013","article-title":"Adult Appendicitis: Clinical Practice Guidelines from the French Society of Digestive Surgery and the Society of Abdominal and Digestive Imaging","volume":"158","author":"Collard","year":"2021","journal-title":"J. Visc. Surg."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1829","DOI":"10.2165\/00003495-200767130-00003","article-title":"Ampicillin\/Sulbactam: Current Status in Severe Bacterial Infections","volume":"67","author":"Rafailidis","year":"2007","journal-title":"Drugs"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"S337","DOI":"10.1093\/cid\/ciaa1513","article-title":"Diagnosis and Management of Intraabdominal Infection: Guidelines by the Chinese Society of Surgical Infection and Intensive Care and the Chinese College of Gastrointestinal Fistula Surgeons","volume":"71","author":"Wu","year":"2020","journal-title":"Clin. Infect. Dis. Off. Publ. Infect. Dis. Soc. Am."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1136\/postgradmedj-2020-138452","article-title":"Recommended Antimicrobial Therapy for Common Inpatient Infections: A Comparative Review of Guidelines across 51 Hospital Trusts in England","volume":"97","author":"Pan","year":"2021","journal-title":"Postgrad. Med. J."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1128","DOI":"10.1016\/j.jpedsurg.2023.02.027","article-title":"Postoperative Antibiotics for Complicated Appendicitis in Children: Piperacillin\/Tazobactam Versus Ceftriaxone with Metronidazole","volume":"58","author":"Zeineddin","year":"2023","journal-title":"J. Pediatr. Surg."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.ijantimicag.2006.04.005","article-title":"Ciprofloxacin\/Metronidazole versus Beta-Lactam-Based Treatment of Intra-Abdominal Infections: A Meta-Analysis of Comparative Trials","volume":"28","author":"Matthaiou","year":"2006","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1016\/j.jpedsurg.2021.11.009","article-title":"Ceftriaxone with Metronidazole versus Piperacillin\/Tazobactam in the Management of Complicated Appendicitis in Children: Results from a Multicenter Pediatric NSQIP Analysis","volume":"57","author":"Kashtan","year":"2022","journal-title":"J. Pediatr. Surg."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"e995","DOI":"10.1097\/SLA.0000000000003704","article-title":"Ceftriaxone Combined with Metronidazole Is Superior to Cefoxitin Alone in the Management of Uncomplicated Appendicitis in Children: Results from a Multicenter Collaborative Comparative Effectiveness Study","volume":"274","author":"Kashtan","year":"2021","journal-title":"Ann. Surg."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1089\/sur.2018.234","article-title":"Comparative Effectiveness of Ceftriaxone plus Metronidazole versus Anti-Pseudomonal Antibiotics for Perforated Appendicitis in Children","volume":"20","author":"Hamdy","year":"2019","journal-title":"Surg. Infect."},{"key":"ref_56","first-page":"57","article-title":"Once-Daily Ceftriaxone Plus Metronidazole Versus Ertapenem and\/or Cefoxitin for Pediatric Appendicitis","volume":"6","author":"Hurst","year":"2017","journal-title":"J. Pediatr. Infect. Dis. 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