Fishbone foreign body ingestion in duodenal papilla: a cause of abdominal pain resembling gastric ulcer
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CASE REPORT
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Fishbone foreign body ingestion in duodenal papilla: a cause of abdominal pain resembling gastric ulcer Lizhi Yi1*†, Zhengyu Cheng1†, Yafei Zhou2†, Qin Wang1, Yangyang Liu1, Ke Liu1, Tao Wang3 and Xianfei Zhong1
Abstract Background: Foreign body ingestion is a common clinical problem. The upper esophagus is the most common site of foreign body, accounting for more than 75% of all cases, but cases with a foreign body in the duodenal papilla or common bile duct are rarely reported. Case presentation: Herein, we report a rare case that a patient’s abdominal pain resembling gastric ulcer was caused by a 3 cm long fishbone inserted into the duodenal papilla. Conclusion: Fishbone inserted into the duodenal papilla can cause an abdominal pain resembling gastric ulcer. Endoscopy is useful for the diagnosis and treatment of fishbone ingestion in clinical. Keywords: Fishbone, Foreign body, Duodenal papilla, Abdominal pain
Background Foreign body ingestion is a common diagnosis in clinical practice. Patients with foreign body ingestion usually present with odynophagia, dysphagia, the feeling of being stuck, chest or abdominal pain, vomiting and other symptoms [1]. The upper esophagus is the most common site of foreign body, accounting for more than 75% of all cases, but cases with a foreign body in the duodenal papilla or in the common bile duct are very rare [1, 2]. Here, for the first time we reported a 3 cm long fishbone inserted into the duodenal papilla, which resulted in the abdominal pain resembling gastric ulcer. Case presentation A 52-year-old woman visited our hospital because of intermittent abdominal pain for half a month. She had no symptoms of melena, hematemesis or fever. The pain * Correspondence: [email protected] † Lizhi Yi, Zhengyu Cheng and Yafei Zhou contributed equally to this work. 1 Department of Gastroenterology, People’s Hospital of Leshan, Leshan, Sichuan, People’s Republic of China Full list of author information is available at the end of the article
was localized to upper abdomen and regularly aggravated after taking meals. This patient had a gastric ulcer with bleeding cured 20 years ago. Besides that, she has no other significant medical history. Physical examination showed that there was a mild tenderness but not rebound tenderness in the upper abdomen. Owing to the history of gastric ulcer, a gastroscopy was performed, which indicated something protruding from the duodenal papilla with a patchy erosion below (Fig. 1a and b). Since the object was covered by mucus and bile, it was difficult to distinguish what it was. Based on this situation, we came up with the method that using a foreign body forceps to gently clamp the object. Thereafter, it was clamped and slowly pulled out from the duodenal papilla. To our surprise, it was a fishbone about 3 cm long (Fig. 2). After removing the foreign body, a small amount of blood was observed on the duodenal papilla (Fig. 1c), but there was no persistent bleeding after washing it with normal saline. After the operation, patien
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