Abstract
Accidental ingestion of animal bones, including fish bones, often goes unnoticed and rarely leads to acute medical complications. However, in rare cases, fish bones can perforate the gastrointestinal tract, causing serious complications such as perforation, abscess formation, or fistula development, necessitating emergent surgical intervention. This case report describes a rare case of gastric perforation by a fish bone ingestion, complicated by perigastric and hepatic abscesses. The patient initially presented to a rural emergency department with acute abdominal pain, where limited imaging resources posed a diagnostic challenge. After repeated rural emergency department presentations, a definitive diagnosis was only established after the patient was transferred to a tertiary center and evaluated using computed tomography (CT) imaging. This helped to guide appropriate surgical management, and an emergency laparotomy was performed, which was followed by an uneventful recovery. We emphasize the critical role of CT imaging in diagnosing fish bone perforation, discuss common sites of perforation, and highlight the need to consider this pathology as a differential diagnosis in patients with undifferentiated abdominal pain.