Three cases of fishbone migration to bile ducts after pancreaticoduodenectomy

Abstract

Fishbones that have migrated into the bile duct are a rare cause of bile duct stones. Even after pancreaticoduodenectomy, fishbones can migrate into the bile duct and act as a nidus for stone formation. We experienced three cases of bile duct stones formed around fishbones after pancreaticoduodenectomy for pancreatic cancer treated with endoscopic retrograde cholangiography (ERC) using a balloon endoscope. Case 1 was an 80-year-old male, the time between the surgery and the diagnosis of bile duct stones was 46.5 months, and the bile duct stones were found due to elevated hepatobiliary enzymes. Case 2 was a 72-year-old male, the time between the surgery and the diagnosis of bile duct stones was 70.5 months, and the bile duct stones were found due to cholangitis. Case 3 was an 83-year-old man with a 10.3-month interval between the surgery and the diagnosis of bile duct stones, which was detected by a follow-up CT scan, which also revealed a postoperative recurrence of pancreatic cancer. In all cases, the stones were successfully removed by ERC using a balloon endoscope. Since fish-eating habits are common in Japan and the number of cases with surgically altered anatomy increases along with the rising incidence of pancreatic cancer, careful attention should be paid to the risk of bile duct stones formed around fishbones.