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

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.

Unusual Pancreatic Abscess Secondary to Embedded Fish Bone: A Challenging Clinical Scenario

“…In most clinical presentations, the nonspecific features of acute abdominal pain represent a challenging scenario [ 5 ]. Furthermore, the lack of a precise history of fish bone ingestion often leads to a diagnostic dilemma and increases morbidity due to the delayed diagnosis of complications and untimely treatment [ 6 ]. Imaging studies are highly effective in diagnosing this condition.…”

“…Plain film radiography is a commonly used initial screening technique for detecting ingested fish bone; however, it is unreliable because of the variable degrees of radiopacity, depending on the fish species [ 6 ]. Ultrasound investigation techniques are also effective for diagnosing abscesses and linear hyperechoic structures resembling fish bones; however, these techniques have a high degree of operator dependence and are subject to interpretive errors.…”

“…Contrast-enhanced CT should be performed to evaluate unexplained and persistent abdominal discomfort and obtain crucial information regarding the relationship of an endoscopically undetectable foreign body with surrounding organs before selecting a therapeutic approach. Laparoscopic surgery is a safe and quick procedure for removing a long penetrating fish bone embedded in a solid organ and surrounding a multiloculated abscess simultaneously, as in our case [ 6 ]; this technique is also associated with shorter postoperative length of stay at the hospital and few complications.…”

Foreign Glass Bodies in Pleura and Pancreas: Systematic Review for Entry Hypotheses and Treatment Options in an Unresolved Case

“…In fact, there are at least 7 known cases where relatively large glass shards deep within the body were overlooked. 8,17,18,37,60,[62][63][64] In addition, it is possible that the foreign bodies have undergone significant migration from their original location. The initial entry point and any overlooked scars may have been in a less expected and more peripheral location.…”

“…It is estimated that around 1% of swallowed foreign bodies penetrate the gastric and duodenal wall, traveling within the abdominal cavity and potentially reaching the liver, pancreas, spleen or even further into the thoracic cavity. 28,33 Our literature review revealed 41 cases of intrapancreatic foreign bodies (Table 3), including 14 suture needles, [23][24][25][26][27][28][29][30][31] 4 metal wires, [32][33][34][35] 19 fish bones, 7,[36][37][38][39][40][41][42][43][44][45][46][47][49][50][51][52][53][54] 2 other pointed bones 55,56, and 2 toothpicks. 57,58 All these foreign bodies are believed to have migrated from the stomach or the duodenum.…”