Gastric Perforation due to Fish Bone Ingestion: a Case Report

Wada, Yoshiki; Sasao, Wataru; Oku, Takatomi

doi:10.14442/jgfm.17.4_315

Cited by 7 publications

(17 citation statements)

References 12 publications

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“…During the clinical course, since the fish bone migrated into the bile duct, there were no specific abnormalities, such as pain or inflammation associated with perforation. As such, we considered transpapillary foreign body migration as the most likely route of migration, as previously described [ 25 ]. In six cases (37.5%) reported in Japan, migration through the duodenal papilla was considered [ 10 , 15 – 19 ].…”

Section: Discussionmentioning

confidence: 99%

A case of a common bile duct stone that formed around a fish bone as a nidus after distal gastrectomy with Roux-en-Y reconstruction

2021

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Background The presence of a foreign body in the common bile duct (CBD) is a rare phenomenon. Thus, the route and mechanism of its migration remain difficult to fully clarify, especially for cases that occur after gastrectomy with Roux-en-Y reconstruction. Herein, we present a case of a CBD stone that formed around a fish bone as a nidus subsequent to distal gastrectomy with Roux-en-Y reconstruction. Case presentation A 70-year-old man was admitted to our hospital due to repeated episodes of epigastralgia. He had undergone distal gastrectomy with Roux-en-Y reconstruction for gastric cancer approximately 10 years prior. Blood tests revealed obstructive jaundice, hepatobiliary dysfunction, and inflammation. Multi-plane reconstructed computed tomography (CT) revealed a CBD stone with a needle-shaped calcification density at the center, oriented along the length of the CBD. Surgery was performed using an upper median laparotomy approach. Lithotomy with choledochotomy was performed to remove one fragile bilirubin stone that had formed around a 3-cm, needle-shaped fish bone. A choledochoduodenal fistula was not detected intraoperatively. A review of the imaging of a prior examination revealed that the formation of the CBD stone around the fish bone was observable on a follow-up CT performed approximately 2 years prior. However, no clinical symptoms associated with the migration of the fish bone to the CBD were reported and the fish bone was not detected at that time. Conclusion In this case, transpapillary migration of the fish bone could only be speculated in the absence of an observable fistula, choledochostomy, or any clinical symptoms. Our case is clinically relevant as cholangitis developed after CBD stone formation around the fish bone that acted as a nidus.

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Section: Discussionmentioning

confidence: 99%

A case of a common bile duct stone that formed around a fish bone as a nidus after distal gastrectomy with Roux-en-Y reconstruction

2021

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“…Unintentional ingestion of fish bones is common, and most fish bones pass through the gastrointestinal tract within a week, without symptoms or complications [1,2]. Gastrointestinal perforations occur in less than 1% of all patients, and may affect any segment from the esophagus to the rectum.…”

Section: Discussionmentioning

confidence: 99%

Gastric Perforation due to Fish Bone

Proença

Bogalho

2020

Cureus

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Unintentional ingestion of fish bones is a common but frequently unrecognized occurrence at the emergency room. Most ingested fish bones pass through the gastrointestinal tract without complications, but approximately 1% may perforate and cause acute abdomen, peritonitis and/or abscesses, requiring emergent surgery.Clinical presentation is non-specific and computed tomography is essential to confirm the diagnosis and guide the surgery.We present a case of gastric perforation by fish bone and discuss the clinical and radiological challenges in the diagnosis of this condition.

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“…Fishbone penetration/perforation of the stomach is rare [3], the most common sites are the ileum, the ileocecal junction, and the rectosigmoid colon [4]. Accordingly, the diagnosis of fishbone penetration/perforation is clinically challenging, because a simple radiography imaging has a limited sensitivity of only 32%.…”

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confidence: 99%

“…Generally, surgery is the recommended treatment when there is a foreign body perforation [1]. Nevertheless, like Wada et al [3] and Ngan et al [5] described, if penetrating fishbones are identified early, namely in the absence of or with mild peritonitis, endoscopic extraction may be possible and should be attempted. There are several devices that can be used to retrieve this kind of sharp foreign bodies (rat-tooth, alligator-tooth, or shark-tooth), the choice of retrieval device is determined by the size and shape of the foreign body and by the endoscopist’s preference and practice [1, 2].…”

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confidence: 99%