LAUSR

diagnosis. Our patient was afebrile having raised white blood count and normal C-reactive protein. Abdominal X-ray is usually not diagnostic because of the low calcium content of a fishbone, being obscured by surrounding soft tissues and fluids. Ultrasound is sensitive in detecting radiotransparent foreign bodies. Nevertheless, its value is limited in obese patients or presence of dilated bowel loops filled with gas. Furthermore, CT scan may miss a fishbone which may look like a blood vessel or being obscured by the oral contrast. In the presence of clinical non-resolving significant intraperitoneal inflammation without established diagnosis, diagnostic laparoscopy is indicated. Primary repair of the perforation can be performed in the absence of gross contamination. This can be done by laparoscopy or laparotomy. The bowl loop did not look healthy in our patient so we felt safer to perform a resection and anastomosis. The laparoscopy helped us to perform a mini-laparotomy. If the diagnosis of ingested fishbone was established by endoscopy, endoscopic extraction, antibiotics and active observation may avoid surgery. In summary, our case highlights that advanced technology should not replace detailed history taking and clinical examination. Our decision for surgery with a favourable outcome was mainly clinical despite the distracting radiological workup.