Two cases of gastric penetration by fish bones with differin
Most foreign bodies swallowed accidentally are naturally excreted from the body. However, in rare cases, some of them cause gastrointestinal penetration and require treatment. Gastrointestinal penetration by a fish bone is common in the lower gastrointestinal tract, but cases of gastric penetration are rare, likely due to anatomical and physiological features such as the thick stomach wall and wide lumen, as well as the digestive action of gastric acid.

Gastric penetration by fish bones often requires surgical treatment. In a few cases, endoscopic treatment is also performed. To the best of our knowledge, there have been no cases of gastric penetration of fish bones that were treated conservatively with antibiotics alone. Patients with gastric penetration or perforation caused by fish bones can follow various clinical courses. Two cases of gastric perforation by fish bones that followed different courses are presented.

A 78-year-old woman developed abdominal pain after eating a fish pot dish. Her abdominal pain gradually increased, and she was brought to our hospital by ambulance 2 days later. Laboratory investigation showed an increased white blood cell count of 14?000 mm3 and a C-reactive protein level of 10.13 mg/dl on arrival. Abdominal computed tomography (CT) showed a linear high-intensity structure that penetrated the anterior wall of the antrum of the stomach outside the stomach wall, along with inflammatory findings outside the stomach wall and thickening of the stomach wall.

No evidence of penetration into other organs was observed. Esophagogastroduodenoscopy showed scars on the anterior wall of the antrum, but no fish bones could be detected. No linear high-intensity echo could be confirmed even with endoscopic ultrasonography. She was treated conservatively with antibiotics alone. Follow-up CT after 2 months showed that the inflammatory findings had disappeared, as well as the symptoms. She is currently being followed carefully.

A 69-year-old woman ate grilled fish 4 days earlier. She developed epigastric pain that increased gradually, so she consulted her family doctor. Laboratory investigation showed an increased white blood cell count of 16?100 mm3 and a C-reactive protein level of 29.89 mg/dl. Because of the high inflammatory findings, she was referred to our hospital. She was taking warfarin and aspirin after undergoing aortic and mitral valve replacement and tricuspid valve plasty. Abdominal CT showed a linear, high-intensity structure that penetrated the posterior wall of the antrum of the stomach outside the stomach wall, and inflammatory findings outside the stomach wall and thickening of the stomach wall. The findings suggested that the tip of the fish bone may have been stuck in the pancreas.

A hematoma was seen in the retroperitoneum. The patient’s general condition was poor, and endoscopy could not be performed. Although a surgeon was consulted, the patient was treated with antibiotics because of heart disease and oral antithrombotic drugs. The oral antithrombotic drugs obviously had an effect on her condition, particularly the hematoma, but the penetration of fish bones into the pancreas was a serious problem. A few days later, surgery was considered because of the growing hematoma and penetration into the pancreas, but it was postponed due to a severe heart attack for which she required intensive care to prepare for surgery. However, surgery was not performed because of serious cardiac complications, no pancreatic organ damage and control of the hematoma. She is under close follow-up after discharge.

Source: https://academic.oup.com/omcr/article/2021/7/omab060/6324923
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