Science and Education Publishing American Journal of Medical Case Reports 2374-216X 4 9 2016 9 28 Sigmoid Colon Perforation Caused by an Ingested Fish Bone: A Case Report 301 303 EN Pyong Wha Choi Department of Surgery, Inje University College of Medicine, Ilsan Paik Hospital, 170, Juhwa-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-do, 10380, Korea AJMCR2016492 10.12691/ajmcr-4-9-2 2016 4 7 2016 8 15 2016 9 26 The accidental ingestion of a foreign body is common, and the majority of ingested foreign bodies pass through the gastrointestinal tract without complication. Perforation is one of the rarest complications and commonly occurs in the terminal ileum and recto-sigmoid junction. The sigmoid colon is an extremely rare site of perforation because of its anatomical features of a thick wall, large diameter, and non-angulation. Here, we present a case of sigmoid colon perforation caused by an ingested fish bone. A 56-year-old male patient presented with left lower abdominal pain. The patient had no past medical history and had eaten a steamed cod dish the day before presentation. His abdomen was slightly distended and the left lower abdomen was tender, with no signs of generalized peritoneal irritation. Computed tomography revealed a linear radio-dense foreign body protruding from the sigmoid colon lumen accompanied by infiltration and a small amount of free air. An emergency operation was performed. During the operation, a 4-cm-long fish bone (a portion of a fish head bone) was found protruding from the sigmoid colon. Intraoperative colonic lavage, primary resection, and anastomosis were performed. The postoperative course was uneventful, and the patient was discharged on the ninth postoperative day. The case represents an unusual case of sigmoid colon perforation caused by an ingested fish bone. Because colon perforation by ingested fish bone is extremely rare, and its preoperative diagnosis is difficult, meticulous history taking is crucial for the correct diagnosis and prompt management in the emergency setting.