Impaction of a Shrapnel Splinter in the Common Bile Duct After Migrating from the Right Thoracic Cavity: Report of a Case

Abstract

Biliary obstruction is rarely caused by a foreign body. This report describes the case of a 60-year-old Japanese man with jaundice caused by an impacted shrapnel splinter in the common bile duct (CBD) that had migrated from the right thoracic cavity 36 years after initial injury. Biochemical data showed a total bilirubin level of 4.2 mg/dl with a direct bilirubin level of 3.1mg/dl, an alanine aminotransferase level of 24IU/l, and an alkaline phosphatase level of 18.5KA units. It was serially documented that the shrapnel had migrated toward the diaphragm, then burrowed into the liver, settling in the CBD, and causing obstructive jaundice. Choledochotomy and T-tube drainage was performed and the postoperative course was uneventful. To our knowledge, this is the first case report of this type of occurrence in the Japanese literature. Although there are few reports of combat injury in Japan, this diagnosis should be considered in the evaluation of any patient with jaundice who has suffered a previous chest wound involving a foreign body.

Common Bile Duct Stone Caused by a Fish Bone: Report of a Case

“…This is only the second report in the literature of a choledochal stone forming around an ingested fish bone in a patient with no history of previous choledochal surgical intervention. Tomato skin 6,9 Spoon handle 19 Nonabsorbable suture 15 Gun bullets 14 Fasciola 18 Vegetable fibers 22 Sewing needle 20 Rubber tube 16 Shrapnel splinter 25 Jujube seed 11 Woody fiber 21 T-tube 26 Chicken bone 23 Gauze 27 Cherry stalk 7 Fish bone 12,13 …”

Percutaneous Nephrolithotomy for Removal of a Calcified Intra-Renal Artillery Shell Fragment

“…An additional challenge arose as the authors working in a tertiary endourology centre attempted to remain as minimally invasive as possible, but were limited by the very nature of the foreign body. organs and limbs [3,4]. They then may cause aneurysms, bleeding, cysts or other pathologic changes in organs adjacent to formerly dormant fragments, sometimes after many years.…”

Obstructive jaundice due to a textiloma mimicking a common bile duct stone

“…Foreign bodies in the common bile duct (CBD) are rarely reported to cause obstructive jaundice. Objects such as tomato skin, shrapnel splinters, fish bones, surgical suture materials, T‐tube fragments, and surgical clips have been reported . There is a single case report that described the endoscopic retrieval of a surgical gauze from the CBD .…”