Maimonides Medical Center Great Neck, NY, United States
Award: Presidential Poster Award
Kaveh Zivari, MD1, Neha Sharma, MBBS1, Avleen Kaur, MD1, Amina Kureshi, 2, Stanley Yakubov, MD1, Ira E. Mayer, MD, FACG1 1Maimonides Medical Center, Brooklyn, NY; 2New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY
Introduction: Fish-bone-induced pancreatitis is an extremely unusual cause of pancreatitis, with only a few reported cases in the literature. CT imaging is key for the visualization of the fish bone. Management includes either endoscopic removal of the fishbone or exploratory laparotomy. Here we present a case of pancreatitis secondary to accidental fish-bone ingestion, identified during an upper endoscopy.
Case Description/Methods: A 64-year-old male presented with worsening epigastric pain for 2 days. The pain was intermittent and non-radiating. CT-abdomen showed a 3.3 cm fish-bone perforating from the distal stomach into the head of the pancreas. An Upper GI endoscopy was done. The foreign body was grasped with a pediatric biopsy forceps and withdrawn through the overtube. One hemoclip was placed at the site of perforation. The patient’s pancreatitis was treated with IV hydration after the removal of the fishbone.
Discussion: Fish-bone is one of the most commonly ingested foreign bodies, however, less than 1% of the ingested foreign bodies result in bowel perforation. Complications of foreign body ingestion include bowel perforation, superior mesenteric vein thrombosis, and bacteremia. The most common sites of perforation are the terminal ileum, sigmoid colon, rectum, and C-loop of the duodenum. Duodenal perforation and penetration of the pancreas resulting in pancreatitis is an exceedingly rare presentation of accidental fish bone ingestion. The symptoms range from nondescript abdominal pain to pancreatitis-like pain that radiates to the back. Lab values can show leukocytosis, and elevated pancreatic amylase and lipase. The CT scan can show the location of the bone, which can be retrieved via upper endoscopy, or exploratory laparotomy, in cases where the bone is far advanced into the body of the pancreas.