Preoperative Diagnosis of a Fish Bone in the Retroperitoneal Space and its Laparoscopic Removal: A Case Report

Abstract

A 43-year-old male visited our emergency department due to left flank pain and, despite spontaneous alleviation, revisited after 1 week due to pain recurrence. CT showed a linear high-density area on the anterior aspect of the left iliopsoas muscle and increased density of the surrounding adipose tissue, and transduodenal entry of a fish bone into the retroperitoneal space was diagnosed. The patient did not remember swallowing a fish bone. Since the flank pain persisted, surgical treatment was selected. Under laparoscopy, a 34-mm-long fish bone present in the left retroperitoneal space near the Treitz ligament and surrounding granuloma were removed. The postoperative course was uneventful, and the patient was discharged. Perforation or penetration of the duodenum by a fish bone is rare, accounting for 0.4-1.9% of such cases in the entire digestive tract, and it is often diagnosed due to abscess formation. In this patient, the fish bone did not cause abscess formation, and it could be diagnosed preoperatively and removed laparoscopically. Perforation or penetration of the digestive tract by a foreign body is considered manageable by laparoscopic surgery if the condition follows a chronic course, and the general condition is stable.