Endoscopic management of fish bone perforation of the 3rd portion of the duodenum leading to retroperitoneal abscess: A case report and literature review

Abstract

Introduction: Most fish bones ingested pass through the gastrointestinal tract without complications. Perforation occurs in less than 1% of cases but this rate increases up to 35% with ingestion of sharp pointed objects. There are only 14 cases of duodenal perforation from fish bone described in the literature thus far. In most of these cases there was no history of ingestion reported which makes diagnosis challenging. Complications from such perforation include hepatic abscess, pancreatic abscess, renal vein thrombus, duodenocaval fistula, and lodgement in common bile duct. 25% of these cases were managed with endoscopy alone without need for surgery. Case Report: We describe a case of a 70-year-old male with perforation involving the third part of the duodenum from a fish bone complicated by retroperitoneal collection. He presented with right-sided abdominal pain and raised inflammatory markers. Initial imaging revealed a foreign body lodged in the third portion of the duodenum with adjacent retroperitoneal fluid. Progress imaging showed new extraluminal gas and inflammation prompting urgent intervention. Endoscopic removal of the fish bone was successful with subsequent resolution of the abscess. Conclusion: In this case, endoscopic removal of the fish bone was successful resulting in early recovery. However, management of duodenal perforation by foreign body can be challenging due to its rarity and myriad of possible management options including conservative, percutaneous, endoscopic, and surgical approaches.