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Fish bone migration after pancreaticoduodenectomy: Incidence and treatment options

Takada, Yoshihisa Ishikawa, Takuya Kawashima, Hiroki Mizutani, Yasuyuki Ohno, Eisaburo Iida, Tadashi Ogawa, Hiroshi Hayashi, Masamichi Takami, Hideki Onoe, Shunsuke Ishigami, Masatoshi 名古屋大学

2022.01

概要

Objective
The migration of a fish bones to the bile duct or pancreatic duct is a possible complication of undergoing a pancreaticoduodenectomy (PD). The aim of this study was to clarify the incidence and indications for intervention in such cases.

Methods
We reviewed the cases of fish bone migration after a PD detected on computed tomography (CT) performed between October 2000 and October 2020 and investigated the incidence, presence or absence of symptoms, treatment options and outcomes.

Results
Among the 1475 pancreaticoduodenectomies performed at our institution during the study period, 14 cases of fish bone migration were noted on CT, at a frequency of 0.95% (14/1475). The time from surgery to the detection of fish bones ranged from 88 to 5902 days (median 917 d). Ten patients remained asymptomatic without therapeutic intervention for up to 2919 days (median 509 d). Four patients were treated by endoscopy, either at the patient's request (n = 1) or because of symptoms (n = 3), and removal was successful in three cases but failed in one case in which the fish bone migrated to the right intrahepatic bile duct. No surgical treatment was required in any case.

Conclusion
The incidence of fish bone migration on CT after PD was about 1%. Some cases resolved spontaneously, and most of the asymptomatic cases required no intervention. For symptomatic cases, endoscopic treatment should be considered first, but it is important to confirm the location of the fish bone by CT and determine whether or not it can be removed.

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参考文献

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