Laparoscopic removal of an ingested fish bone that penetrated the stomach and was embedded in the pancreas: a case report

Emergency Laparoscopic Removal of an Ingested Fishbone Perforating the Stomach After Endoscopy: A Case Report

A 70-year-old female who presented with epigastric pain of two days' duration was reported. Her multi-detector computed tomography (MDCT) images showed peri-gastric fat stranding on MDCT, corresponding to the extra-gastric wall inflammation due to gastric perforation. Laparoscopic surgery was successfully performed to remove the extra-gastric foreign body and repair the perforation with the lesser omentum. To the best of our knowledge, the literature review showed that this is the 10th case of gastric perforation due to a foreign body treated by laparoscopy. The fat stranding is considered indicative of gastric perforation, and laparoscopy must be prepared when gastroscopy fails to remove and save the gastric perforation.

Minimally invasive removal of a foreign body in the pancreas using digital intelligent technology: a case report

Pancreatitis caused by a fish bone penetrating the posterior wall of the stomach and entering the pancreas is rare. We herein report a case involving a woman in her late 30s with an approximately 1-month history of recurrent upper abdominal pain. Initial evaluation at another hospital failed to identify the cause but raised suspicion of pancreatic cancer. Computed tomography, magnetic resonance imaging, and a detailed consultation led us to suspect that the patient's pain had been caused by inadvertent ingestion of a fish bone. We used three-dimensional visualization technology to determine the location of the fish bone and informed the patient of the lesion and surgical plan through a simulated surgical demonstration. During surgery, we applied augmented reality navigation technology to remove the fish bone by a minimally invasive approach. The patient was discharged on postoperative day 3. She was followed up by telephone 24 hours after discharge. Outpatient follow-up was performed 1 week after discharge and on day 30. The patient recovered well and developed no complications. This case shows that digital medical technology can be applied in patients undergoing surgical removal of a pancreatic foreign body. Such technology assists with preoperative evaluation, patient education, and intraoperative trauma reduction.

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

BACKGROUND

Foreign bodies within the pleura and pancreas are infrequent, and the approaches to their treatment still a subject of debate. There is limited knowledge particularly regarding glass foreign bodies.

METHODS

We present a case involving large glass splinters in the pleura and pancreas, with an unknown entry point. In addition, a systematic review was conducted to explore entry hypotheses and management options.

RESULTS

In addition to our case, our review uncovered eight incidents of intrapleural glass, and another eight cases of glass in other intrathoracic areas. The fragments entered the body through impalement (81%), migrated through the diaphragm after impalement (6%), or caused transesophageal perforation (19%) following ingestion. Eight instances of glass inside the abdominal cavity were documented, with seven resulting from impalement injuries and one from transintestinal migration. There were no recorded instances of glass being discovered within the pancreas. Among the 41 nonglass intrapancreatic foreign bodies found, sewing needles (34%) and fish bones (46%) were the most common; following ingestion, they had migrated through either a transgastric or transduodenal perforation. In all these cases, how the foreign bodies were introduced was often poorly recalled by the patient. Many nonglass foreign bodies tend to become encapsulated by fibrous tissue, rendering them inert, though this is less common with glass. Glass has been reported to migrate through various tissues and cavities, sometimes with a significant delay spanning even decades. There are cases of intrapleural migration of glass causing hemothorax, pneumothorax, and heart and major blood vessels injury. For intrapleural glass fragment management, thoracoscopy proved to be effective in 5 reported cases, in addition to our patient. Most intrapancreatic nonglass foreign bodies tend to trigger pancreatitis and abscess formation, necessitating management ranging from laparoscopic procedures to subtotal pancreatectomy. There have been only four documented cases of intrapancreatic needles that remained asymptomatic with conservative management. There is no direct guidance from the existing literature regarding management of intrapancreatic glass foreign bodies. Consequently, our patient is under observation with regular follow-ups and has remained asymptomatic for the past 2 years.

CONCLUSIONS

Glass foreign bodies in the pleura are rare, and our report of an intrapancreatic glass fragment is the first of its kind. Impalement is the most likely method of introduction. As glass has significant migration and an ensuing complication potential, preventive removal of intrapleural loose glass should be considered. However, intrapancreatic glass fragment management remains uncertain.

Incidental Finding of a Fish Bone Perforation in the Pylorus Mimicking Acute Cholecystitis

We present a case of a 43-year-old man with Crohn's disease who presented with epigastric and right upper quadrant abdominal pain, initially suspected to be acute cholecystitis or a Crohn's flare-up. CT revealed a curvilinear, hyperdense foreign body adjacent to the duodenum, concerning micro-perforation. Endoscopic examination confirmed findings of a 3 cm fish bone lodged in the pylorus. Endoscopic extraction was successful without significant mucosal damage, and the patient recovered well postoperatively. This case highlights the rarity of pyloric perforation secondary to fish bone ingestion and highlights the importance of considering this diagnosis in patients presenting with unexplained acute abdominal pain, as prompt recognition and intervention are essential for favorable outcomes.

Pancreatitis from posterior gastric wall perforation by ingested metallic wire-case report and review of literature

Gastric and duodenal perforation from ingested organic and inorganic foreign bodies, such as sewing needles, toothpick, metallic wires, fish and chicken bone, are uncommon incidents as most foreign bodies pass in the faeces. The perforated foreign body can at times migrate and either penetrate causing traumatic injury or incite inflammation with formation of abscesses or pseudo-tumours in the adjacent organs such as the liver and pancreas. We report one such case of pancreatitis in a child resulting from a metallic wire perforating the posterior gastric wall and penetrating the pancreas. The findings were detected on CT and the foreign body was extracted endoscopically. We also present review of literature on similar case reports.

An ingested metallic wire migrating from stomach to pancreas treated by laparoscopic surgery: A case report

INTRODUCTION

Foreign bodies inside the pancreas are rare and usually occur after the ingestion of sharp objects such as a fish bone, a sewing needle, or a toothpick. Furthermore, an ingested metallic wire migrating from stomach to pancreas is very rare.

CASE PRESENTATION

We report a 36-year-old woman who was admitted to our hospital with "3-day history of dull progressive epigastric pain." Computed tomography of the abdomen revealed a linear, high-density body between the stomach wall and the pancreas. During the operation, a linear, hard, metallic wire was found in the adhesive tissue between the gastric antrum and the pancreatic body. The operation was uneventful, and the patient recovered well.

CONCLUSION

The case of a foreign body inside the pancreas caused by a metallic wire is very rare. Radiological examinations play a vital role in the diagnosis of metallic wire ingestion. Metallic wire ingestion can be treated with laparoscopic surgery, both technically and safely.

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

The incidental ingestion of fish bone is common, and the ingested fish bone mostly exits the gastrointestinal tract spontaneously. However, severe complications such as perforation in the digestive tract and abscess formation after a period of time may occasionally occur. Fewer than 10 cases of a migrated fish bone penetrating into the pancreas have been reported in the literature, and the development of a subsequent pancreatic abscess is extremely rare. We present one such rare case of pancreatic abscess formation in a middle-aged woman due to fish bone penetration through the gastric wall into the pancreas 2 months after ingestion and missed on endoscopy initially. Further imaging revealed that the fish bone was partially embedded in the pancreatic head surrounded with abscesses and was smoothly removed through laparoscopy.

Misdiagnosis of acute pancreatitis in a patient with foreign body ingestion: a case report and literature review

Foreign body ingestion is a rare but important clinical event. We herein describe a patient who was misdiagnosed with acute pancreatitis after inadvertent ingestion of a toothpick while drunk. The toothpick penetrated the stomach and migrated to the pancreas, resulting in abdominal pain for nearly 1 month. We present the clinical manifestations, diagnosis, and treatment of the patient and summarize the characteristics of patients with foreign body ingestion by a systematic literature review. This report illustrates an unusual of misdiagnosed acute pancreatitis caused by foreign body. This case reminds us to make full use of different diagnostic tools and multidisciplinary collaboration to leverage their complementary strengths and improve the diagnostic accuracy.

Endoscopic Removal of an Intramurally Ingrown Foreign Body in the Angular Fold of the Stomach

Eine 67-jährige Patientin mit chronischer Gastritis stellte sich wegen zunehmenden epigastrischen Schmerzen in der Notaufnahme vor. Auf Grund einer nicht wegweisenden Initialdiagnostik wurde eine Computertomographie des Abdomens durchgeführt. In dieser stellte sich ein Fremdkörper am Magenausgang dar. Unter radiologischer Kontrolle erfolgte ein anspruchsvolles, zeitintensives endoskopisches Freipräparieren des Fremdkörpers. Nach postinterventionellem Abschwellen der Schleimhaut konnte in einer zweiten Sitzung ein Fischknochen geborgen werden. Die aufwendige endoskopische Intervention bewahrte die Patientin vor einer Operation.

Augmented reality navigation facilitates laparoscopic removal of foreign body in the pancreas that cause chronic complications

BACKGROUND

Foreign bodies that enter the pancreas and cause chronic complications cannot be removed by endoscopy. Surgical removal is necessary but also challenging. The development of augmented reality navigation has made it possible to accurate intraoperative navigation in laparoscopic surgery.

METHODS

A 37-year-old female had epigastric pain for 3 months and her abdominal CT showed a linear high-density shadow in her pancreas along with chronic pancreatitis. Three-dimensional models of the liver, pancreas, stomach, blood vessels, and foreign body were created based on CT images. Gastroptosis was found in the three-dimensional models, so surgical approach was adapted to open the hepatogastric ligament to reach the pancreas. After 2-3 s of video images were captured by 3D laparoscopy, a three-dimensional dense stereo-reconstruction method was used to obtain the surface model of pancreas, stomach, and blood vessels. The Globally Optimal Iterative Closest Point method was used to obtain a spatial transformation matrix between the preoperative CT image space and the intraoperative laparoscopic space. Under augmented reality navigation guidance, the position and location of the foreign body were displayed on the surface of the pancreas. Then intraoperative ultrasound was used for further verification and to quickly and easily confirm the surgical entrance. After minimal dissection and removal of the pancreatic parenchyma, the foreign body was removed completely.

RESULTS

The operation time was 60 min, the estimated blood loss was 10 ml. The foreign body was identified as a 3-cm-long fishbone. The patient recovered without complications and was discharged on the third postoperative day.

CONCLUSION

Because it enables direct visual navigation via simple operation, ARN facilitates the laparoscopic removal of foreign bodies in the pancreas with accurate and rapid positioning and minimal damage.

Spontaneous resolution of gastric perforation caused by an ingested foreign body: a case report

Foreign body ingestions are commonly seen and are usually uneventful. Very rarely, ingested foreign bodies will cause perforation of the gastrointestinal tract, which can lead to peritonitis, abscesses or fistulation. This is the case of a patient with vague abdominal pain after voluntary ingestion of bleach and an ink pen. The ink pen was found lodged in the gastric antral wall on esophagogastroduodenoscopy. The foreign body spontaneously migrated into the gastric lumen and was successfully removed with endoscopy.

Swallowed Metallic Spoon Causing Doudeno-Jejunal Junction Perforation in a 13-Year-Old Child: Case Report

Background

A child swallowing a long metallic spoon is an extremely rare phenomenon. Foreign bodies longer than 6 cm are unlikely to pass through the gastrointestinal tract spontaneously and require endoscopic or surgical removal in order to avoid associated complications, such as visceral perforations.

Case Details

A 13-year-old child presented with accidental swallowing of a metallic spoon 10 days prior to hospital admission. He had history of loss of appetite, epigastric and left upper quadrant abdominal pain and started to have high grade intermittent fever 11 days after swallowing the spoon. A plain abdominal radiograph revealed a metallic spoon in the mid-abdomen. An exploratory laparotomy revealed an 11 cm long metallic spoon impacted at the duodeno-jejunal junction with walled off perforation and erosion of the mesentery of the colon. The metallic spoon was removed and the perforated site was repaired. The surgery was smooth and the patient recovered fully and was discharged seven days post-operation.

Conclusion

A swallowed long metallic spoon is unlikely to pass spontaneously and should be removed as soon as possible in order to avoid associated complications like impaction, perforation and subsequent peritonitis.

Two cases of gastric penetration by fish bones with differing courses

Most foreign bodies swallowed accidentally are naturally excreted. Gastric penetration by a fish bone is rare due to anatomical and physiological features such as the thick stomach wall, wide lumen and gastric acid. The most common penetration site is the antral region. The clinical course of fish bone penetration of the gastric antrum may differ depending on the direction of penetration. In this report, two cases of gastric perforation by fish bones that followed different courses are presented. One case was treated conservatively with antibiotics alone, and another case was considered for surgery, due to increased hematoma and penetration of the fish bone into the pancreas. However, the patient's comorbidities were so severe that surgery was not possible, resulting in meticulous follow-up. Diagnostic imaging was important in these cases.

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

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.

Laparoscopic removal of a fishbone migrating from the gastrointestinal tract to the pancreas

Laparoscopic surgery can be performed safely for the removal of a foreign body embedded in the pancreas and should be preferred instead of open surgery, whenever possible.

Laparoscopic removal of an aberrant acupuncture needle in the gluteus that reached the pelvic cavity: a case report

Background

Intrapelvic aberrant needles are rare in clinical practice. Long-term foreign bodies in the abdominal cavity may form granulation tissue or an abscess, and may cause organ injury. Therefore, such foreign bodies need prompt removal.

Case presentation

A 26-year-old male athlete was referred to our hospital for investigation of an aberrant acupuncture needle in the gluteus. The needle was unable to be removed during acupuncture treatment, and the end broke off and remained in the gluteus. Abdominal X-ray examination showed a thin, 40-mm-long, metallic foreign body resembling an acupuncture needle. Abdominal computed tomography showed an abnormal shadow in the gluteus. However, it was unclear whether the tip of the needle reached the pelvic cavity. Thus, it was decided to surgically extract the needle via laparoscopic surgery under X-ray guidance as a safe and minimally invasive method. Although X-ray fluoroscopy confirmed that the aberrant needle was located in the gluteus, the needle could not be felt with the forceps, as the peritoneum surrounding the needle had granulomatous changes due to inflammation. Therefore, the retroperitoneum was further dissected to search for the needle. Once the needle was identified, its flexibility enabled it to be easily removed by grasping it directly with a needle holder. The length of the aberrant needle was 40 mm. The postoperative course was uneventful, and the patient was discharged from hospital on postoperative day 2.

Conclusions

When a foreign body remains in the gluteus and its tip touches intrapelvic organs, such as the rectum, it is critical to determine the best approach for its safe removal. Given the anatomical location of the foreign body and the patient background, laparoscopic removal was considered the best approach in the present case.

Laparoscopic removal of an ingested fish bone from the head of the pancreas: case report and review of literature

Most ingested foreign bodies pass spontaneously through the gastrointestinal tract and only 1% of them can perforate or penetrate the wall of stomach and duodenum and migrate into organs, such as the liver and pancreas. We report herein the case of a 59-year-old woman who presented to the emergency department with epigastric pain and fever. Computed tomography of the abdomen revealed a linear foreign body that perforate the posterior wall of the prepyloric region of the stomach. The foreign body was removed laparoscopically in one piece and was identified as a 3-cm-long fish bone. The patient recovered without complications and was discharged on the 4th postoperative day. Pancreatic foreign body is a rare entity and laparoscopic removal is warranted in majority of cases.

Laparoscopic diagnosis and extraction of an ingested fish bone that penetrated the stomach: A case report

RATIONALE

Foreign body ingestion is a common clinical event, but serious complication such as perforation is uncommon. Here we present a case of gastrointestinal perforation caused by fish bone, which was treated effectively and successfully by totally laparoscopic management.

PATIENT CONCERNS

A 63-year-old man who was admitted to our hospital with epigastric pain for 1 month. Computed tomography of the abdomen at the local hospital revealed a linear, hyperdense, foreign body in the lesser curvature of gastric antrum that had penetrated through the posterior wall of the gastric antrum.

DIAGNOSIS

The laparoscopic exploration found that a 2.5 cm × 0.3 cm fish bone had penetrated through the posterior wall of the gastric antrum.

INTERVENTIONS

A totally laparoscopic surgery was performed to remove the foreign body and repair the perforation eventually.

OUTCOMES

After surgery, the patient underwent uneventful recovery and was discharged on postoperative day 7. During the 3 months of follow-up visit, the patient appeared healthy and did not report abdominal symptoms.

LESSONS

In this case, the advantages of laparoscopic techniques in the diagnosis and treatment of gastrointestinal perforation caused by foreign body was confirmed, and which may be considered as the primary choice in similar cases.