A case of penetration through the horizontal portion of the duodenum by a fish bone

Abstract

A 70-year-old man ate a boiled sea bream one week before being admitted to hospital with a two-day history of upper abdominal pain. Tenderness was localized in the left upper region. Abdominal CT scan revealed a linear, high density lesion measuring about 10 mm in length and free air in the adipose tissue near the horizontal portion of the duodenum. Gastrointestinal endoscopy was performed to extract the foreign body but it could not be seen in the intestinal lumen. A laparotomy was done after the patient's of abdominal pain improved on conservative therapy. The small intestine and adipose tissue where the foreign body was thought to have penetrated were swollen for about 4 cm around the Treitz ligament. When the adipose tissue near the Treitz ligament was dissected a fish bone about 10 mm in length was detected in the mesentery of the jejunum. A Partial resection from the horizontal portion of the duodenum to the jejunum and an end-to-end anastomosis were performed. In the Japanese literature 26 cases of perforation and penetration of the duodenum and 8 cases of penetration of the horizontal portion of the duodenum by a fish bone have been reported.