Migration of fish bones into abdominal para‐aortic tissue from the duodenum after leading to duodenal perforation: a case report

Abstract

Background Migration of fish bones into abdominal para-aortic tissue after penetrating the junction of 3rd and 4th part of duodenum is incredibly rare. Case presentation A 68-year-old man was admitted to our hospital with persistent colic in the lower abdomen after eating fish two weeks ago. Abdominal computed tomography (CT) scan showed High density streaks along the anterior and lower edges of the 3rd part of duodenum with peripheral exudation and localized peritonitis. Esophagogastroduodenoscopy didn’t find foreign bodies and perforations in the digestive tract. Laparoscopic surgery and intraoperative endoscopy were made to detect foreign bodies and perforation site was found. After transition to open surgery, the fish bone was found in abdominal para-aortic tissue and removed without complications. Postoperative recovery is smooth, and the patient resumed normal diet and was discharged. Conclusions It is difficult to choose a treatment plan for foreign bodies at the 3rd part of the duodenum, because it is difficult to judge the damage caused by the foreign body to the intestine and the positional relationship with the surrounding important organs. Conservative treatment or surgical treatment both have huge risks. The handling of this situation will extremely test the psychology, physical strength and professional experience of the surgeon.

Endoscopic management of a duodenal diverticulum fishbone microperforation: a feasible alternative to an operative approach

“…Indeed, the patient made an uncomplicated post‐procedural recovery and avoided operative intervention and its potential associated risks. Although fishbone perforation of the duodenum has been reported in the literature previously, to our knowledge, this is the first case report documenting an exclusively conservative approach with endoscopy to a duodenal diverticulum microperforation 7–10 …”

“…Although fishbone perforation of the duodenum has been reported in the literature previously, to our knowledge, this is the first case report documenting an exclusively conservative approach with endoscopy to a duodenal diverticulum microperforation. [7][8][9][10] Surgery is still considered standard of care in patients with signs of peritonitis and contraindications to this approach would include a free abdominal duodenal leak, an associated collection or an extraluminal location of the fishbone. However, we propose that in stable patients, endoscopic retrieval of a foreign body in the setting of microperforation is a potentially safe alternative to an operative approach.…”

The role of immature granulocyte in the early prediction of gastrointestinal tract perforations

“…Gastrointestinal (GI) perforation is defined as the disruption of tissue integrity in the GI canal wall due to an ulcer, trauma, foreign body, and/or cancer [8]. GIT perforation is a common medical emergency associated with considerable mortality, which ranges from 30% to 50% [9].…”

Duodenal and inferior vena cava perforation due to a rosemary branch ingestion: a Case Report

“…Approximately 1500 deaths occur in the United States annually because of ingestion of FB. [1]. More than 300 cases of bowel perforation caused by foreign bodies have been reported in the literature.…”