scholarly journals Ingested Fish Bone: An Unusual Mechanism of Duodenal Perforation and Pancreatic Trauma

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Dimitrios Symeonidis ◽  
Georgios Koukoulis ◽  
Ioannis Baloyiannis ◽  
Apostolos Rizos ◽  
Ioannis Mamaloudis ◽  
...  
Keyword(s):  
Foreign Body ◽  
Epigastric Pain ◽  
Elevated Serum ◽  
Delayed Diagnosis ◽  
Pancreatic Head ◽  
Fish Bone ◽  
Postoperative Recovery ◽  
Intestinal Lumen ◽  
Duodenal Wall ◽  
Duodenal Perforation

Ingestion of gastrointestinal foreign bodies represents a challenging clinical scenario. Increased morbidity is the price for the delayed diagnosis of complications and timely treatment. We present a case of 57-year-old female patient which was admitted in the emergency room department complaining of a mid-epigastric pain over the last twenty-four hours. Based on the patient's history, physical examination and elevated serum amylase levels, a false diagnosis of pancreatitis, was initially adopted. However, a CT scan confirmed the presence of a radiopaque foreign body in the pancreatic head and the presence of air bubbles outside the intestinal lumen. The patient was unaware of the ingestion of the foreign body. At laparotomy, after an oblique duodenotomy, a fish bone pinned in the pancreatic head after the penetration of the medial aspect of the second portion of the duodenal wall was identified and successfully removed. The patient had an uneventful postoperative recovery. Wide variation in clinical presentation characterizes the complicated fish bone ingestions. The strategically located site of penetration in the visceral wall is responsible for the often extraordinary gastrointestinal tract injury patterns. Increased level of suspicion is of paramount importance for the timely diagnosis and treatment.

scholarly journals Internal Herniation through Foramen of Winslow: A Diagnosis Not to be Missed

2016 ◽  
Vol 9 ◽  
pp. CGast.S38453 ◽  
Author(s):  
Edmund Leung ◽  
Simon Bramhall ◽  
Prajeesh Kumar ◽  
Moustafa Mourad ◽  
Amdad Ahmed
Keyword(s):  
Epigastric Pain ◽  
Primary Anastomosis ◽  
Delayed Diagnosis ◽  
Postoperative Recovery ◽  
Emergency Laparotomy ◽  
Cross Sectional ◽  
Foramen Of Winslow ◽  
Lesser Sac ◽  
Cross Sectional Imaging ◽  
Severe Epigastric Pain

Introduction Hernias through the foramen of Winslow are extremely rare, accounting for 0.1% of all abdominal hernias. Delayed diagnosis is often observed, resulting in bowel strangulation and high mortality. Method We present a case of a patient with strangulated ileum herniated through the foramen of Winslow. Recent literature review was undertaken on “PubMed” as a search platform using the keywords “foramen of Winslow” and “hernia”. Case Summary A 66-year-old man presented acutely with severe epigastric pain and vomiting. An emergency computed tomography scan revealed a loop of ileum in the lesser sac. At emergency laparotomy, a herniated loop of ileum that had become strangulated at its entry to the lesser sac via the foramen of Winslow was confirmed. The loop of ileum was reduced but was nonviable, which had to be resected with a primary anastomosis. The patient's postoperative recovery was uneventful. Conclusion Herniation through the foramen of Winslow is a difficult diagnosis and must not be missed. Early cross-sectional imaging and surgical intervention are advised in order to reduce morbidity.

scholarly journals A Bile Duct Stone Formation around a Fish Bone as a Nidus after Pancreatoduodenectomy

2018 ◽  
Vol 12 (1) ◽  
pp. 69-75 ◽  
Author(s):  
Tomoki Sakakida ◽  
Hideki Sato ◽  
Toshifumi Doi ◽  
Takumi Kawakami ◽  
Yoshikazu Nakatsugawa ◽  
...  
Keyword(s):  
Foreign Body ◽  
Bile Duct ◽  
Rare Case ◽  
Bile Duct Stone ◽  
Epigastric Pain ◽  
Stone Formation ◽  
Fish Bone ◽  
Pathological Examination ◽  
Single Balloon ◽  
Single Balloon Enteroscopy

We report a rare case of bile duct stone formation around an ingested fish bone as a nidus after pancreatoduodenectomy. A 78-year-old woman was admitted to our department for fever and epigastric pain. Abdominal computed tomography revealed an elongated bile duct stone containing a linearly shaped foreign body of bone density. Enteroscopic lithotomy was performed using single balloon enteroscopy to safely remove the stone and foreign body from the bile duct. The foreign body was determined to be a fish bone by pathological examination and component analysis.

scholarly journals Successful laparoscopic treatment for sustained abdominal pain due to fish bone migrating into the neck of the pancreas: a case report and thinking about surgical approach through the literature review

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yang Wang ◽  
Xianzhang Luo ◽  
Jiefeng Zhang
Keyword(s):  
Laparoscopic Surgery ◽  
Foreign Body ◽  
Epigastric Pain ◽  
Posterior Wall ◽  
Final Diagnosis ◽  
Fish Bone ◽  
Upper Gastrointestinal Endoscopy ◽  
Case Presentation ◽  
Pancreatic Neck ◽  
Pass Through

Abstract Background The majority of ingested foreign bodies pass through the gastrointestinal tract smoothly, with less than 1% requiring surgery. Fish bone could perforate through the wall of stomach or duodenum and then migrate to other surrounding organs, like the pancreas and liver. Case presentation We report herein the case of a 67-year-old male who presented with sustained mild epigastric pain. Abdominal computed tomography revealed a linear, hyperdense, foreign body along the stomach wall and pancreatic neck. We made a final diagnosis of localized inflammation caused by a fish bone penetrating the posterior wall of the gastric antrum and migrating into the neck of the pancreas. Upper gastrointestinal endoscopy was performed firstly, but no foreign body was found. Hence, a laparoscopic surgery was performed. The foreign body was removed safely in one piece and was identified as a 3.2-cm-long fish bone. The patient was discharged from the hospital on the fifth day after surgery without any postoperative complications. Conclusion Laparoscopic surgery has proven to be a safe and effective way to remove an ingested fish bone embedded in the pancreas.

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

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rong Wang ◽  
Jinyan He ◽  
Zhengquan Chen ◽  
Kunming Wen
Keyword(s):  
Foreign Bodies ◽  
Treatment Plan ◽  
Fish Bone ◽  
Postoperative Recovery ◽  
Normal Diet ◽  
Duodenal Perforation ◽  
Aortic Tissue ◽  
Case Presentation ◽  
Physical Strength ◽  
Fish Bones

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.

scholarly journals EP.TH.691Necrotic Liver Abscess secondary to Duodenal Perforation caused by ingestion of a Fish Bone – A Case Report

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Shazmeen Surtee ◽  
Adam O'Connor ◽  
Mazyar Fani ◽  
Ahmed Hassan ◽  
Thomas Satyadas ◽  
...  
Keyword(s):  
Case Report ◽  
Foreign Bodies ◽  
Hepatic Abscess ◽  
Fish Bone ◽  
Magnetic Resonance Images ◽  
Source Control ◽  
Duodenal Wall ◽  
Duodenal Perforation ◽  
Lower Quadrant ◽  
Endoscopic Retrieval

Abstract Introduction Ingestion of foreign bodies are not uncommon, however enterohepatic migration of fish bones causing liver abscesses remains a rare phenomenon. Case Report We present the case of a 58-year-old female admitted with 11 days history of fever, rigors, shortness of breath and malaise associated with vomiting and diarrhoea. Her COVID-19 rapid antigen test was negative. She was tender in the left lower quadrant of her abdomen and inflammatory markers were markedly high so initial differential diagnosis included colitis and diverticulitis. Contrast Computed Tomography of the abdomen and pelvis showed an 8.1cm irregular hepatic lesion initially thought to be a multi-loculated abscess, malignancy or complex cyst. She was started on broad-spectrum antibiotics, escalated to Intensive Care Unit (ICU) and discussed at the hepato-biliary multi-disciplinary team (MDT) where magnetic resonance images demonstrated a perforated duodenum from a 2.5cm fish bone penetrating from the duodenal wall into the liver parenchyma causing a necrotic abscess. She underwent percutaneous drainage of the hepatic abscess. Endoscopic retrieval was then attempted; however, the fish bone was not visualised. Definitive management followed with laparoscopic removal of the fish bone and primary duodenal repair. Discussion Identification of the cause of the abscess during MDT discussion enabled prompt source control which was key in managing intra-abdominal sepsis – radiological drainage in the first instance prevented secondary peritonitis from a potentially ruptured abscess and enabled the patient to be de-escalated from ICU. Previous literature suggests endoscopic retrieval however, laparoscopic surgery remains safer for managing complications following removal of sharp foreign bodies.

Fish Bone Foreign Body in a Zenker's Diverticulum: A Case Report

2017 ◽  
Vol 68 (3) ◽  
pp. 240-244
Author(s):  
Sumiyo Saburi ◽  
Yoichiro Sugiyama ◽  
Hideki Bando ◽  
Ryuichi Hirota ◽  
Yasuo Hisa ◽  
...  
Keyword(s):  
Case Report ◽  
Foreign Body ◽  
Fish Bone ◽  
Zenker’S Diverticulum ◽  
Zenker's Diverticulum

scholarly journals Management of scope-induced type I duodenal perforations: Over-the-scope clip versus surgery

2021 ◽  
Author(s):  
Amol S. Dahale ◽  
Siddharth Srivastava ◽  
Sundeep Singh Saluja ◽  
Sanjeev Sachdeva ◽  
Ashok Dalal ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Delayed Diagnosis ◽  
Oral Intake ◽  
Standard Of Care ◽  
Duodenal Perforation ◽  
Type I ◽  
Over The Scope Clip ◽  
Group 2 ◽  
Duodenal Perforations ◽  
Surgical Group

Abstract Background Scope-induced duodenal perforation is a life-threatening complication and surgery remains the standard of care. With the advent of over-the-scope clip (OTSC), scope-induced perforations are increasingly managed conservatively, though there is no study comparing this form of non-surgical treatment with surgery. We aimed to compare OTSC and surgery in the management of scope-induced perforation of the duodenum. Methods We retrospectively collected data of scope-induced duodenal perforation patients. Perforations identified and treated within 24 h of procedure were analyzed. Factors analyzed were spectrum, etiology, baseline parameters, perforation size, outcome, comorbidities, and duration of hospital stay. Results A total of 25 patients had type I duodenal perforations, out of whom five were excluded due to delayed diagnosis and treatment. Of the twenty, eight were treated with OTSC placement while the rest underwent surgery. Age was comparable and the majority were females. Baseline parameters and comorbidities were similar in both the groups. The median size of perforation was 1.5 cm in both the OTSC group and the surgical group. All patients were treated with standard of care according to institutional protocols. Patients in the OTSC group were started orally after 48 h of OTSC placement, while in the surgery group median time to oral intake was 7 days. Two patients in the surgical group died while there was no mortality in the OTSC group (p = 0.48). Median hospital stay was shorter in the OTSC group (2 days vs. 22 days, p = 0.003). Conclusions OTSC is a feasible and better option in type I duodenal perforations with a shorter hospital stay.

scholarly journals Intraorbital wooden foreign body detected by computed tomography and magnetic resonance imaging

2016 ◽  
Vol 30 (1) ◽  
pp. 88-91 ◽  
Author(s):  
Alfredo Di Gaeta ◽  
Francesco Giurazza ◽  
Eugenio Capobianco ◽  
Alvaro Diano ◽  
Mario Muto
Keyword(s):  
Computed Tomography ◽  
Foreign Body ◽  
Magnetic Resonance ◽  
Delayed Diagnosis ◽  
Clinical History ◽  
Definitive Diagnosis ◽  
Double Vision ◽  
Resonance Imaging ◽  
Wooden Foreign Body ◽  
The Right

To identify and localize an intraorbital wooden foreign body is often a challenging radiological issue; delayed diagnosis can lead to serious adverse complications. Preliminary radiographic interpretations are often integrated with computed tomography and magnetic resonance, which play a crucial role in reaching the correct definitive diagnosis. We report on a 40 years old male complaining of pain in the right orbit referred to our hospital for evaluation of eyeball pain and double vision with an unclear clinical history. Computed tomography and magnetic resonance scans supposed the presence of an abscess caused by a foreign intraorbital body, confirmed by surgical findings.

Granulomatosis with polyangiitis presenting as pancreatic disease

2021 ◽  
Vol 14 (3) ◽  
pp. e241033
Author(s):  
Jessie Jia Tao ◽  
Arnav Agarwal ◽  
Ari Benjamin Cuperfain ◽  
Christian Pagnoux
Keyword(s):  
Granulomatosis With Polyangiitis ◽  
Epigastric Pain ◽  
Delayed Diagnosis ◽  
Pancreatic Disease ◽  
Small Vessel Vasculitis ◽  
High Dose ◽  
Rapid Progression ◽  
Radiographic Evidence ◽  
High Index Of Suspicion ◽  
Parenchymal Lung

Granulomatosis with polyangiitis (GPA) is a rare necrotising small vessel vasculitis typically associated with oronasal, pulmonary and renal manifestations. Pancreatic disease is an exceedingly rare initial presentation and is associated with delayed diagnosis and rapid progression. We discuss a 66-year-old woman presenting with epigastric pain, elevated lipase and radiographic evidence of focal pancreatitis. She had no relevant medical history and no lithiasis seen on imaging. Pertinent findings include strawberry gingivitis, positive proteinase-antineutrophil cytoplasm antibody (98% specificity) and focal nodular parenchymal lung lesions on CT chest—all of which are consistent with a diagnosis of GPA. She was promptly started on high-dose steroids which resulted in significant clinical and biochemical improvement. Cyclophosphamide was added once biopsy confirmed the absence of malignancy. In order to optimise the clinical outcomes of GPA, physicians must keep a wide differential and high index of suspicion in the setting of unexplained pancreatitis with systemic features.

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