Mima Kosuke, Sugihara Hidetaka, Kato Rikako, Matsumoto Chihiro, Nomoto Daichi, Shigaki Hironobu, Kurashige Junji, Inoue Mitsuhiro, Iwagami Shiro, Mizumoto Takao, Kubota Tatsuo, Miyanari Nobutomo
Department of Surgery, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan.
Surg Case Rep. 2018 Dec 29;4(1):149. doi: 10.1186/s40792-018-0559-4.
The gastrointestinal tract can occasionally be perforated or penetrated by an ingested foreign body, such as a fish bone. However, there are very few reported cases in which an ingested fish bone penetrated the gastrointestinal tract and was embedded in the pancreas.
An 80-year-old male presented with epigastric pain. Computed tomography of the abdomen showed a linear, hyperdense, foreign body that penetrated through the posterior wall of the gastric antrum. There was no evidence of free air, abscess formation, migration of the foreign body into the pancreas, or pancreatitis. As the patient had a history of fish bone ingestion, we made a diagnosis of localized peritonitis caused by fish bone penetration of the posterior wall of the gastric antrum. We first attempted to remove the foreign body endoscopically, but failed because it was not detected. Hence, an emergency laparoscopic surgery was performed. A linear, hard, foreign body penetrated through the posterior wall of the gastric antrum and was embedded in the pancreas. The foreign body was safely removed laparoscopically and was identified as a 2.5-cm-long fish bone. Intraperitoneal lavage was performed, and a drain was placed in the lesser sac. The patient recovered without complications and was discharged on the 7th postoperative day.
Laparoscopic surgery could be performed safely for the removal of an ingested fish bone embedded in the pancreas.
胃肠道偶尔会被摄入的异物(如鱼刺)穿孔或穿透。然而,很少有报道称摄入的鱼刺穿透胃肠道并嵌入胰腺。
一名80岁男性因上腹部疼痛就诊。腹部计算机断层扫描显示一个线性、高密度的异物穿透胃窦后壁。没有游离气体、脓肿形成、异物迁移至胰腺或胰腺炎的证据。由于患者有鱼刺摄入史,我们诊断为胃窦后壁鱼刺穿透引起的局限性腹膜炎。我们首先尝试通过内镜取出异物,但未成功,因为未检测到异物。因此,进行了急诊腹腔镜手术。一个线性、坚硬的异物穿透胃窦后壁并嵌入胰腺。通过腹腔镜安全地取出了异物,经鉴定为一根2.5厘米长的鱼刺。进行了腹腔灌洗,并在小网膜囊放置了引流管。患者恢复顺利,无并发症,术后第7天出院。
对于取出嵌入胰腺的摄入鱼刺,腹腔镜手术可以安全地进行。