Ingested Fish Bone: An Unusual Mechanism of Duodenal Perforation and Pancreatic TraumaReport as inadecuate

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Case Reports in Gastrointestinal MedicineVolume 2012 2012, Article ID 308510, 3 pages

Case ReportDepartment of General Surgery and Radiology, University Hospital of Larissa, Mezourlo, 41110 Larissa, Greece

Received 11 June 2012; Accepted 10 July 2012

Academic Editors: T. Hirata, R. J. L. F. Loffeld, W. S. Selby, and C. T. Shun

Copyright © 2012 Dimitrios Symeonidis et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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.

Author: Dimitrios Symeonidis, Georgios Koukoulis, Ioannis Baloyiannis, Apostolos Rizos, Ioannis Mamaloudis, and Konstantinos Tepetes



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