Purpose

Migration of fish bones to the bile duct or pancreatic duct is a possible complication following pancreaticoduodenectomy (PD). The aim of this study was to clarify the incidence and indications for intervention in such cases.

Methods

We reviewed the cases of fish bone migration after PD detected on CT performed between October 2000 and October 2020, and the incidence, presence or absence of symptoms, treatment options, and outcomes were investigated.

Results

Among the 1475 pancreaticoduodenectomies performed at our institution during the study period, 14 cases of fish bone migration were noted on CT, resulting in a frequency of 0.95% (14/1475). The time from surgery to the detection of fish bones ranged from 88 to 5902 days (median 917 days). Ten patients remained asymptomatic without therapeutic intervention for up to 2919 days (median 509 days). Four patients were treated by endoscopy, either at the patient's request (n=1) or because of symptoms (n=3), and removal was successful in 3 cases but failed in 1 case in which the fish bone migrated to the right intrahepatic bile duct. No surgical treatment was required in any case.

Conclusion

The incidence of fish bone migration on CT after PD was about 1%. Some cases spontaneously resolved, and most of the asymptomatic cases did not require intervention. For symptomatic cases, endoscopic treatment should be considered first, but it is important to confirm the location of the fish bone by CT and determine whether or not it can be removed.

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