A Case of a Fish Bone Detected in the Upper Bile Duct after Gastrectomy and Choledochoduodenostomy

Abstract

A case of cholangitis of the right hepatic duct caused by an ingested fish bone is reported. A 70-year-old man developed symptoms of acute cholangitis and was admitted to our hospital two times within the space of half a year. Abdominal CT and MRI showed evidence of acute cholangitis with dilatation of the right hepatic duct. Underlying intrahepatic bile duct cancer was considered as the cause of the relapsing cholangitis and dilatation of the right hepatic duct. Under the suspected diagnosis of intrahepatic bile duct cancer, an exploratory laparotomy was performed. The junction between the duodenum and common bile duct was cut, and the intrabiliary wall was observed with a cholangioscope. A foreign body was found to be stuck to the bile duct wall, which was considered to be the cause of the acute cholangitis. The foreign body was removed endoscopically with forceps. Histopathologically, the foreign body was diagnosed as a bone stump, and the needle-shaped appearance suggested that it was a fish bone. This is the first reported case of an ingested fish bone found in the upper bile duct.