Conventional folk wisdom and culinary practice recommend removal of bay leaves (Laurus nobilis) from food before serving because of possible internal trauma.1–4 We describe a case in which a 46-year-old man suffered intestinal perforation by an ingested bay leaf.
Case report
A previously healthy 46-year-old man was admitted to our Emergency Department with a 1-day history of nausea, abdominal discomfort and tenderness in the right lower quadrant. A provisional diagnosis of acute appendicitis was made. At operation, a normal-appearing appendix was removed through a McBurney incision. The terminal ileum was examined, and an acutely inflamed Meckel’s diverticulum was found and removed by simple wedge resection. The patient made a smooth recovery and was sent home on the second postoperative day.
On pathological examination of the excised specimens, the vermiform appendix was 7 cm long and 0.8 cm in diameter, and was grossly and microscopically normal. The Meckel’s diverticulum consisted of a portion of viscus 4.5 cm long with one end opened; the other end was a blind sac, with an irregular serosal fibrinous membrane 2 cm in diameter. On palpation of the blind end, a sharp object was felt protruding through the serosal surface. When the lumen was opened, a portion of bay leaf, 2 cm long, was found penetrating the bowel wall at an area of mucosal ulceration (Fig. 1). On microscopic examination, the perforation site showed discontinuity of the mucosa associated with fibrin deposition. The serosal surface at that site was covered by a membrane of fibrin infiltrated by polymorphonuclear leukocytes.
Discussion
Cases of viscus perforation due to ingested foreign bodies are frequently described in the literature.5,6 A Meckel’s diverticulum is a common site of perforation, and the ingested foreign body, if it is part of the diet, is usually a fish or chicken bone.6 Foreign bodies of vegetable origin have occasionally been described,7–9 and of these the bay leaf is a frequent cause of perforation. Bay leaves remain more or less intact in the gastrointestinal tract. They are rigid and can have sharp points and margins. Swallowed leaves can be likened to ingested razor blades, and the validity of accumulated folk wisdom can be seen in some accepted culinary practices.