A 45-year-old man in Italy experienced sharp lower-right abdominal pain that suggested appendicitis. Initial ultrasound scans showed no signs of inflammation in his appendix or other abdominal organs. Eight months later, when the man returned to the hospital still in pain, he recalled that approximately 15 years earlier he had accidentally swallowed a piece of bone containing edible marrow.
An abdominal X-ray revealed a round object measuring about 2.5 centimeters long and 3 centimeters wide near his pelvis. A CT scan confirmed the object contained bone tissue and was positioned near the appendix. A laparoscope showed the appendix was enlarged.
Surgeons performed a laparoscopic appendectomy and found inside the appendix a hardened mass of fecal matter, called a fecaloma, that surrounded the long bone. The appendix's muscular walls had stretched from the mass, but no inflammation was present. The patient was discharged two days after surgery with no complications.
The case is unusual because foreign bodies rarely affect the appendix and cause only about 0.005% of appendicitis cases. When foreign objects do enter the appendix, they typically trigger inflammation within a few months. The authors noted their patient was the first documented case in scientific literature of a sizeable bone remaining in an appendix for more than a decade without causing significant inflammation. His pain likely came from physical shifting of the hardened mass rather than true inflammation.