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Ingested fish bone: an unusual mechanism of duodenal perforation and pancreatic trauma.

Symeonidis D, Koukoulis G, Baloyiannis I, Rizos A, Mamaloudis I, Tepetes K - Case Rep Gastrointest Med (2012)

Bottom Line: 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 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.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery and Radiology, University Hospital of Larissa, Mezourlo, 41110 Larissa, Greece.

ABSTRACT
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.

No MeSH data available.


Related in: MedlinePlus

Contrast-enhanced CT image showing the foreign body in the duodenum as well as the presence of air outside the lumen.
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fig1: Contrast-enhanced CT image showing the foreign body in the duodenum as well as the presence of air outside the lumen.

Mentions: The patient was submitted to an abdominal ultrasound that ruled out cholelithiasis as well as any gross pathology emanating from the extrahepatic bile ducts. With a suspected diagnosis of pancreatitis, despite the absence of obvious predisposing factors, the patient was admitted to the department's clinic for observational and supportive management. However, as the patient's condition did not ameliorate after two days of conservative treatment a computed tomography scan (CT) of the abdomen was decided. Surprisingly, a radiopaque foreign body in the pancreatic head, which the patient was not aware of ingesting, in continuity with the duodenum as well as the presence of air bubbles in the area of question suggestive of a probable intestinal perforation was revealed. See Figures 1 and 2.


Ingested fish bone: an unusual mechanism of duodenal perforation and pancreatic trauma.

Symeonidis D, Koukoulis G, Baloyiannis I, Rizos A, Mamaloudis I, Tepetes K - Case Rep Gastrointest Med (2012)

Contrast-enhanced CT image showing the foreign body in the duodenum as well as the presence of air outside the lumen.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3420078&req=5

fig1: Contrast-enhanced CT image showing the foreign body in the duodenum as well as the presence of air outside the lumen.
Mentions: The patient was submitted to an abdominal ultrasound that ruled out cholelithiasis as well as any gross pathology emanating from the extrahepatic bile ducts. With a suspected diagnosis of pancreatitis, despite the absence of obvious predisposing factors, the patient was admitted to the department's clinic for observational and supportive management. However, as the patient's condition did not ameliorate after two days of conservative treatment a computed tomography scan (CT) of the abdomen was decided. Surprisingly, a radiopaque foreign body in the pancreatic head, which the patient was not aware of ingesting, in continuity with the duodenum as well as the presence of air bubbles in the area of question suggestive of a probable intestinal perforation was revealed. See Figures 1 and 2.

Bottom Line: 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 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.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery and Radiology, University Hospital of Larissa, Mezourlo, 41110 Larissa, Greece.

ABSTRACT
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.

No MeSH data available.


Related in: MedlinePlus