Successful ultrasound-assisted endoscopic removal of a fishbone penetrating the full thickness of the antrum wall

A 57-year-old man presented with upper quadrant abdominal pain after had accidental ingestion of a sharp fishbone a few days earlier. Abdominal computed tomography scan demonstrated a hyperdense needle-shaped structure penetrating the stomach wall ([Fig. 1]). Gastroscopy revealed a hemispherical bulge in the anterior wall of the gastric antrum, with a suspicious sinus opening in the center and white secretions attached ([Fig. 2]). Ultrasound gastroscopy showed a linear hyperechoic lesion ([Fig. 3]). Based on these examinations, a diagnosis of full-thickness penetration of the antrum wall by the fishbone was considered, so we performed an endoscopic submucosal dissection to reveal the fishbone ([Fig. 4]). A fishbone, 3 cm in length, was retrieved using rat tooth forceps ([Fig. 5]). The wound was closed with several metal clips and nylon strings ([Video 1]).

Fig. 1 Computed tomography scan showed a hyperdense needle-shaped structure (arrow) penetrating the stomach wall.

Fig. 2 A hemispherical submucosal bulge in the gastric antrum mucosa of a 57-year-old man; the fishbone cannot be seen.

Fig. 3 Endoscopic ultrasonography revealed the location and depth of the fishbone (arrow).

Fig. 4 The fishbone (arrow) was successfully revealed by endoscopic submucosal dissection, and retrieved using a rat tooth forceps.

Fig. 5 The fishbone (about 3 cm).

Video 1 Endoscopic removal of an embedded fishbone in the gastric antrum using rat tooth forceps.

Most ingested foreign bodies pass through the gastrointestinal tract spontaneously without any adverse effects. However, 10 %–20 % require endoscopic removal and about 1 % require early surgery [1]. Complications after foreign body ingestion occur at sites of angulation or physiologic narrowing of the gastrointestinal tract. Accidental ingestion of long, narrow, or pointed foreign bodies, such as fishbones, is associated with a higher risk of impaction and perforation of the gastrointestinal wall [2]. Endoscopic ultrasonography is commonly used to differentiate mucosal lesions from submucosal lesions and thus to avoid misdiagnosis. When impaction of such foreign bodies is diagnosed in time, successful ultrasound-assisted endoscopic management is possible. In the current case, laparoscopic and open surgery were avoided, and the patient recovered well.

Endoscopy_UCTN_Code_TTT_1AO_2AL

Competing interests

The authors declare that they have no conflict of interest.

• References

• 1 Green J, Doughty L, Kaplan SS. et al. Removal of foreign bodies in the upper gastrointestinal tract in adults: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2016; 48: 489-496
• 2 Moscheo C, Cataldo AD, Spreafico F. et al. Toothpick impaction in the sigmoid colon as a cause of chronic abdominal pain. Endoscopy 2010; 42: E203

Publication History

Article published online:
09 March 2023