A 45-year-old man in Italy went to the emergency room with sharp pain in his lower-right abdomen, the kind of discomfort that often signals appendicitis. His appendix was not inflamed. Doctors later found a bone he had swallowed about 15 years earlier, trapped inside it, Live Science reported in a Diagnostic Dilemma feature based on the published case report. Appendicitis can be dangerous if the organ bursts and spreads infection, but this patient had no fever, nausea, dehydration, or elevated heart rate. Ultrasound scans of his abdominal organs, including the appendix, also looked normal.
The report's authors did not describe his treatment after that first visit. Eight months later he was still in pain and came back. This time, when asked more carefully about his history, he recalled that about 15 years earlier he had accidentally swallowed a piece of a long bone containing edible marrow. An abdominal X-ray found a round object near the upper right of his pelvis, about an inch (2.5 centimeters) long and a little over an inch (3 centimeters) wide. A CT scan showed that the object contained bone tissue and sat near the appendix. When doctors looked inside with a laparoscope, the appendix was enlarged.
Surgeons performed a laparoscopic appendectomy. Inside the appendix was a hardened mass of fecal matter, called a fecaloma, surrounding a long bone. The organ's muscular walls had been stretched by the mass, but there were still no signs of inflammation. The patient was discharged two days later without complications. The report does not describe follow-up visits.
Swallowed objects rarely end up in the appendix. In the United States, about 120,000 people a year are treated for ingesting foreign objects, roughly 90% of them children, and most items pass through the intestines within 48 hours. Less than 1% require surgery. Objects that do migrate into the appendix typically trigger appendicitis within a few months, the case report said, and they cause only about 0.005% of appendicitis cases. Items recovered in other appendectomies have included coal, nails, enamel, glass, shells, dental crowns, and bullets. This case is unusual because the bone sat for years without inflaming the organ. Another published report described a man who, more than 30 years after eating pigeons as a child, was found to have 27 lead shot pellets in his appendix. The verified lesson is a documented medical oddity, not a reason to assume every stomachache hides a swallowed bone.