Migration of Fish Bones to the Bile Duct Following Hepaticojejunostomy

Migration of fish bones into the bile duct is rare, but can cause bile duct stone formation or acute cholangitis. Herein, we examine the characteristics of this phenomenon.

This single-center, retrospective study enrolled patients with a history of fish bone extraction from the bile duct by an endoscopic procedure at our hospital between June 2016 and November 2023. Patient characteristics, treatment details, and clinical course were assessed from the electronic medical records.

A total of 11 patients were enrolled, including 10 who underwent subtotal stomach-preserving pancreaticoduodenectomy with Child's reconstruction and one who underwent extrahepatic bile duct resection with choledochojejunostomy. The median time between surgery and endoscopic treatment was 84 months (range 12-124). On computed tomography (CT), all fish bones were detected as high-density dots or linear substances in the bile duct. Endoscopic procedures were performed using single-balloon enteroscopy. All fish bones and coexisting biliary stones were successfully removed, with a median duration of 40.5 (range 9-54) minutes. Three cases of mild cholangitis were observed and resolved with conservative treatment. Two patients had recurrence, and all cases were successfully treated endoscopically.

This migration may occur in patients with surgically altered biliary anatomy. Most migrated fish bones can be safely detected by CT, and treated by single-balloon enteroscopy.