We present a case of a fish bone impacted in the papilla of Vater resulting in dyspepsia and mild elevation in liver function tests, which was subsequently treated endoscopically. Fish bones are one of the most commonly encountered swallowed foreign bodies. However, involvement of the biliary tract, such as the one described by us, represents an extremely rare complication of fish bone ingestion. The diagnosis of a foreign body in the biliary tract can be difficult, and early endoscopic or surgical extraction may be required to avoid complications such as biliary stone formation, obstructive jaundice, cholangitis or cholecystitis, and/or biliary sepsis. Prompt endoscopic treatment can avoid severe biliary complications or surgical therapy.

Department of Gastroenterology and Internal Medicine University Hospital Brno Faculty of Medicine Masaryk University Brno Czechia

Department of Internal Medicine Hospital Boskovice Boskovice Czechia

Department of Surgery University Hospital Brno Faculty of Medicine Masaryk University Brno Czechia

Division of Digestive and Liver Diseases Columbia University Medical Center New York New York USA

See more in PubMed

ASGE Standards of Practice Committee. Ikenberry SO, Ikenberry SO, Jue TL, Anderson MA, Appalaneni V, Banerjee S, et al. Management of ingested foreign bodies and food impactions. Gastrointest Endosc. 2011 Jun;73((6)):1085–91. PubMed

Weiland ST, Schurr MJ. Conservative management of ingested foreign bodies. J Gastrointest Surg. 2002 May-Jun;6((3)):496–500. PubMed

Ngan JH, Fok PJ, Lai EC, Branicki FJ, Wong J. A prospective study on fish bone ingestion. Experience of 358 patients. Ann Surg. 1990;211((4)):459–62. PubMed PMC

Bathla G, Teo LL, Dhanda S. Pictorial essay: complications of a swallowed fish bone. Indian J Radiol Imaging. 2011;21((1)):63–8. PubMed PMC

Birk M, Bauerfeind P, Deprez PH, Häfner M, Hartmann D, Hassan C, et al. Removal of foreign bodies in the upper gastrointestinal tract in adults: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2016 May;48((5)):489–96. PubMed

Wu C, Hungness ES. Laparoscopic removal of a pancreatic foreign body. JSLS. 2006;10((4)):541–3. PubMed PMC

Wang WG, Zhang Y, Wang L, Chen Y, Tian BL. Chronic pancreatic inflammatory granuloma caused by foreign body presenting as a pancreatic pseudotumor: a case report and literature review. Pancreatology. 2015;15((5)):573–5. PubMed

Beh JC, Uppaluri AS, Koh BF, Cheow PC. Fishbone perforated appendicitis. J Radiol Case Rep. 2016;10((7)):14–22. PubMed PMC

Matsubayashi H, Sawai H, Tanaka M, Hotta K, Ono H. Endoscopic removal of foreign body from hepatic duct using wire guided forceps and basket. J Interv Gastroenterol. 2012;2((2)):86–7. PubMed PMC

Hussain Z, Malik SM, Rasool A, Mattoo S. Rare causes of foreign body in CBD: a retrospective study. JK Sci. 2015;17:209–11.

Brunaldi VO, Brunaldi MO, Masagao R, Silva C, Masuda H, Brunaldi JE. Toothpick inside the common bile duct: a case report and literature review. Case Rep Med. 2017;2017:5846290. PubMed PMC

Giestas S, Mendes S, Gomes D, Sofia C. Obstructive jaundice due to foreign body in the bile duct: an unusual finding. GE Port J Gastroenterol. 2016;23((4)):228–30. PubMed PMC

Yu M, Huang B, Lin Y, Nie Y, Zhou Z, Liu S, et al. Acute obstructive cholangitis due to fishbone in the common bile duct: a case report and review of the literature. BMC Gastroenterol. 2019;19((1)):177. PubMed PMC