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case_images: The abdominal CT findings revealed localized thickening and clustering of the small bowel wall in the right abdominal cavity with comminuted fracture of the right 11th rib protruding into the abdominal cavity. (A): Axial view of an abdominal CT scan; (B): Coronal view of an abdominal CT scan; (C): Sagittal of an abdominal CT scan.
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case_images: A comminuted fracture of the right 11th rib protruding into the abdominal cavity was observed, with a bone fragment located within the intestinal mass (Figure 1).
case_images: Changes in the small intestine under continuous stimulation of rib tissues (red box). (A): First record of a comminuted fracture of the right 11th rib protruding into the abdominal cavity accompanied by intestinal obstruction. (B): Small bowel aggregation around bone tissue. (C): The inflammatory mass has formed. (D): Thickening of the small bowel wall. (E): Uneven thickening of the small bowel wall and formation of a tumor.
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case_images: Thus, prolonged stimulation of intra-abdominal bone tissue against the adjacent SB induced adhesion, an inflammatory mass, and thickening of the intestinal wall, culminating in the eventual development of tumors (Figure 2).  
case_images: Surgical treatment procedure. (A): The rib end penetrates the abdominal cavity and is encircled by intertwined segments of the ileum, forming a mass. The head of the appendix was located within the mass (white arrow). (B and C): The rib end was removed and the abdominal wall was repaired. (D): Confirmed by postoperative CT scan (white box).
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case_images: We also excised the rib end and repaired the abdominal wall to prevent further irritation (Figure 3). 
case_images: Postoperative specimens and pathology findings. (A): Anatomical examination revealed irregular thickening of the small bowel wall with the formation of internal fistulas between the intestinal walls and partial rib fragments located within the tumor cavity. (B): Pathological examination revealed raised-type, moderately differentiated adenocarcinoma of the small intestine, with mucinous adenocarcinoma components infiltrating all layers. No lymph node involvement was observed (0/10). IHC: CDX-2(+), CK20(+), CK7(-), Ki-67(+70%), MLH1(+), MSH2(+), MSH6(+), PMS2(+). (C): All rib tissues removed from the abdominal cavity. (D): Mucinous adenocarcinoma components were found on the surface of the rib within the tumor cavity (yellow arrow), and (E): No cancer cells were observed on the rib end.
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case_images: Gross examination revealed irregular thickening of the SB wall, internal fistula formation, and rib fragments within the tumor cavity (Figure 4).