Synchronous small bowel neuroendocrine tumour and lymphoma in a centenarian

moid colon, 15 of which have resulted in sigmoid perforation. There was no evidence of perforation in our patient. Most patients are asymptomatic, diagnosed incidentally on surveillance colonoscopy as in our patient, or can present with fever, abdominal pain, vomiting and rectal bleeding which is usually indicative of associated diverticulitis or bowel perforation. Complicated cases involving pericolic abscesses and enterocolonic fistulas have also been reported. CT is the imaging modality of choice given its usefulness in identifying and locating a foreign body with associated complications such as perforation and abscess formation. Classical findings on CT include a linear hyperdense foreign body with surrounding tissue inflammation. Management and time frame for intervention are dependent on the site of the impacted foreign body, chronicity and associated symptoms. Compared with upper gastrointestinal impacted foreign bodies, there is a paucity of evidence to substantiate the time frame for colonoscopic intervention in asymptomatic patients, given that 80% of patients are able to pass colonic foreign bodies unaided. Serial X-rays, abdominal examinations and stool charts are useful for tracking migration and passage in stable patients; however, colonoscopic retrieval is warranted in unsuccessful passage of foreign bodies due to the risk of perforation. Laparoscopic removal of foreign bodies and washout has been previously described for stable patients with Hinchey grade II diverticulitis. Urgent colonic resections are reserved for unwell patients with associated perforation or abscess formation. This case demonstrates a rare and unusual presentation of a chronic, uncomplicated chicken bone impaction in the sigmoid colon with associated diverticulosis successfully retrieved endoscopically. References