A case report of a sigmoid perforation within an inguinoscrotal hernia sac caused by ingestion of a chicken wishbone

Introduction and importance: Ingestion of foreign bodies is common and often harmless. However sharp objects like bones can cause intestinal perforations, particularly at anatomical narrowing points. Diagnosis is challenging due to patients' lack of recollection of ingestion and subtle imaging findings. We present a rare case of a sigmoid perforation within an inguinoscrotal hernia sac caused by a chicken wishbone, discovered during elective hernia repair surgery. Case presentation: A 66-year-old male presented with a left inguinoscrotal hernia causing mild discomfort, but without signs of local infection or an acute abdomen. Preoperative imaging showed sigmoid colon within the hernia sac without complications. During elective surgery, pus and fecal material were drained from the hernia sac, revealing a perforated sigmoid colon with a chicken wishbone protruding. Eight centimeters of inflamed sigmoid colon were resected, and primary anastomosis was performed given the contained perforation and the patient's stable condition. Postoperative complications included anastomotic dehiscence, necessitating further surgeries, however the patient recovered well and remains in good health at 12-month follow-up. Clinical discussion: This case highlights the diagnostic challenge of intestinal perforation by foreign bodies, especially without acute symptoms. Omental adhesion likely sealed the perforation, preventing peritonitis. Conclusion: A sigmoid perforation within an inguinoscrotal hernia sac caused by a chicken wishbone is rare. Effective management requires careful postoperative care. This case contributes to the understanding of intestinal perforations caused by foreign bodies and their unique challenges.