Beyond biliary causes, fish bone perforation as a rare etiology of recurrent fever in a post-Whipple patient: A case report
Year: 2025
Type: article
Study design: Case Report
Abstract: BACKGROUND: Patients who have undergone pancreaticoduodenectomy (Whipple procedure) often develop complex late complications that may be diagnostically challenging. We report a rare cause of recurrent fever and abdominal pain in such a patient: Fish bone-induced jejunal perforation. This case emphasizes the importance of maintaining suspicion for atypical, non-biliary causes in post-Whipple patients with recurrent symptoms, particularly when conventional tests suggest no biliary obstruction. A thorough linear diagnostic approach and multidisciplinary collaboration are essential. The delay in diagnosis highlights the challenges of interpreting subtle imaging findings and correlating them with clinical symptoms mimicking cholangitis. CASE SUMMARY: A 55-year-old female with a Whipple procedure history 10 years earlier presented with recurrent fever and severe abdominal pain. An initial extensive workup, including imaging and laboratory tests, was inconclusive. Only after detailed re-evaluation of the computed tomography images revealed a subtle linear hyperdensity and subsequent deep push enteroscopy was an embedded fish bone in the efferent jejunal limb identified and removed endoscopically. CONCLUSION: Clinicians should consider gastrointestinal foreign body perforation in the differential diagnosis of recurrent fever and abdominal pain in patients with altered anatomy after Whipple procedure. Critical image review and advanced enteroscopic techniques are invaluable for diagnosing obscure causes in complex cases.
Source: World Journal of Clinical Cases
Institutions: King Fahad Specialist Hospital, Zamzam University College
Language: English
Topic: Foreign Body Medical Cases
Subfield: Radiology, Nuclear Medicine and Imaging
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7117244018