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Open Access
CC BY 4.0 · Endoscopy 2025; 57(S 01): E1052-E1053
DOI: 10.1055/a-2686-7898
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A rare case of submucosal foreign body in the duodenal bulb

Authors

  • Weizhao Wang  ‡

    1   Department of Endoscopy Center, Clinical Medical College of Yangzhou University, Northern Jiangsu People’s Hospital, Yangzhou, China (Ringgold ID: RIN370089)

  • Mengxian Ju‡

    2   Department of Endocrinology, Clinical Medical College of Yangzhou University, Northern Jiangsu People’s Hospital, Yangzhou, China (Ringgold ID: RIN370089)

  • Bin Deng

    1   Department of Endoscopy Center, Clinical Medical College of Yangzhou University, Northern Jiangsu People’s Hospital, Yangzhou, China (Ringgold ID: RIN370089)

  • Jun Liu

    1   Department of Endoscopy Center, Clinical Medical College of Yangzhou University, Northern Jiangsu People’s Hospital, Yangzhou, China (Ringgold ID: RIN370089)

  • Weiwei Han

    1   Department of Endoscopy Center, Clinical Medical College of Yangzhou University, Northern Jiangsu People’s Hospital, Yangzhou, China (Ringgold ID: RIN370089)

  • Xiaoyin Wang

    3   Department of Anesthesiology, Clinical Medical College of Yangzhou University, Northern Jiangsu People’s Hospital, Yangzhou, China (Ringgold ID: RIN370089)

  • Chao Sun

    1   Department of Endoscopy Center, Clinical Medical College of Yangzhou University, Northern Jiangsu People’s Hospital, Yangzhou, China (Ringgold ID: RIN370089)
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A 59-year-old woman was hospitalized with intermittent upper abdominal pain of 2 months’ duration. She was previously in good health. Physical examination revealed epigastric tenderness without rebound pain. Her complete blood test, liver, renal, coagulation function, and tumor markers were within reference values.

Gastroscopy at an outside hospital 1 month ago suggested chronic gastritis with no abnormalities in the duodenal bulb. After admission, abdominal CT showed a 13.9-mm-long spindle-shaped high density in the duodenal bulb. A foreign body (FB) was considered ([Fig. 1]). Gastroscopy showed a 15 mm × 15 mm mass in the duodenal bulb, mucosal edema, and a small patchy ulcer on the surface ([Fig. 2]). Ultrasound gastroscopy showed a hyperechoic space with a cross-section of approximately 2 mm × 2 mm in the submucosal layer and muscularis propria of the duodenal bulb mass ([Fig. 3]). The patient was diagnosed with a submucosal FB in the duodenal bulb, After obtaining the patient’s consent, we decided to perform a transgastroscopic mucosal incision to remove the FB ([Video 1]). After performing the mucosal incision, we visualized a bar-shaped bony FB buried in the mass ([Fig. 4]). After sufficient separation of the FB, the FB was removed using a FB forceps, which was approximately 14 mm in length ([Fig. 5]), and the wound was finally closed with metal clips.

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Fig. 1 Abdominal CT showed a 13.9-mm-long spindle-shaped high density in the duodenal bulb.
Zoom
Fig. 2 Gastroscopy showed a 15 mm × 15 mm mass in the duodenal bulb, mucosal edema, and a small patchy ulcer on the surface.
Zoom
Fig. 3 Ultrasound gastroscopy showed a hyperechoic space with a cross-section of approximately 2 mm × 2 mm in the submucosal layer and muscularis propria of the duodenal bulb mass.
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After the gastroscope reached the location of the duodenal bulb mass, a mucosal incision was performed and a bar-shaped bony FB was found buried within the mass. After adequate separation of the FB, the FB was removed, which was approximately 14 mm in length, and the wound was finally closed with metal clips.Video 1

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Fig. 4 After performing the mucosal incision, we visualized a bar-shaped bony FB buried in the mass.
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Fig. 5 Bone FB was successfully removed, length about 14 mm.

We removed the bone FB intact with no complications. She was then questioned and had no memory of swallowing the bone and was successfully discharged home after conservative treatment. No symptoms were found during the three-month follow-up, and she was unwilling to repeat the gastroscopy and CT.

Bone FB in the duodenal bulb is common [1] [2], but submucosal FB in the duodenal bulb is very rare, and we have searched a large number of literature to find almost no similar cases. Bone FB in this area often leads to bleeding, perforation, and abscess formation and can usually be removed endoscopically [3], but in combination with perforation, peritonitis, severe bleeding, and abscess, surgical removal of the FB is often required [1]. Our case is a submucosal FB in the duodenal bulb, with a residence time of more than 2 months, only abdominal pain manifestation, insidious symptoms, and endoscopic observation cannot be detected, and the diagnosis is difficult and needs to be jointly diagnosed by CT, ultrasound endoscopy, etc. For treatment, the removal of the FB after incision of the mucosal layer by gastroscopy is still preferred by this kind of patients, which is safe and effective, and can be used as a reference for clinicians.

Endoscopy_UCTN_Code_TTT_1AO_2AL

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Conflict of Interest

The authors declare that they have no conflict of interest.


Correspondence

Chao Sun, MD
Department of Endoscopy Center, Clinical Medical College of Yangzhou University, Northern Jiangsu People’s Hospital
No. 98, West Nantong Road
225001Yangzhou
China   

Publikationsverlauf

Artikel online veröffentlicht:
11. September 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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Zoom
Fig. 1 Abdominal CT showed a 13.9-mm-long spindle-shaped high density in the duodenal bulb.
Zoom
Fig. 2 Gastroscopy showed a 15 mm × 15 mm mass in the duodenal bulb, mucosal edema, and a small patchy ulcer on the surface.
Zoom
Fig. 3 Ultrasound gastroscopy showed a hyperechoic space with a cross-section of approximately 2 mm × 2 mm in the submucosal layer and muscularis propria of the duodenal bulb mass.
Zoom
Fig. 4 After performing the mucosal incision, we visualized a bar-shaped bony FB buried in the mass.
Zoom
Fig. 5 Bone FB was successfully removed, length about 14 mm.