• Completely embedded
• Endoscopic submucosal fenestration
• Upper gastrointestinal foreign body

• Humans
• Foreign Bodies/surgery
• Female
• Male
• Adult
• Middle Aged
• Retrospective Studies
• Treatment Outcome
• Young Adult
• Aged
• Upper Gastrointestinal Tract/surgery
• Endoscopic Mucosal Resection/methods
• Endoscopic Mucosal Resection/adverse effects
• Esophagus/surgery
• Adolescent
• Duodenum/surgery

• 82000623 National Natural Science Foundation of China
• 20DZ1100102 Natural Science Foundation of Shanghai
• 2020ZSCX06 Zhongshan Hospital Innovation Fund
• 2021ZSYQ12 Zhongshan Hospital Outstanding Youth Fund

Submucosal protuberance caused by fish bone insertion into the digestive tract has rarely been reported. These cases usually include patients with clear signs such as a history of fish intake, pain, and dysphagia, as well as positive findings on endoscopy and imaging. Here, we report a case of a fish bone hidden in the submucosal protuberance of the gastric antrum during endoscopic submucosal dissection without preoperative obvious positive signs.

A 58-year-old woman presented with epigastric pain for the past 20 d and a submucosal protuberance. Abdominal computed tomography and endoscopic ultrasonography did not indicate the presence of a fish bone. We assumed the cause to be an ordinary submucosal eminence and performed an endoscopic submucosal dissection to confirm its essence. During the operation, a fish bone approximately 20 mm in length was found incidentally.

Our report could potentially prevent the oversight of embedded fish bones and associated adverse effects in patients with similar presentation.

• Gastric submucosal protuberance
• Endoscopic mucosal dissection
• Computed tomography
• Endoscopic ultrasonography
• Case report

• case report
• endoscopic submucosal dissection
• esophagus
• foreign body
• migration

Fishbone ingestion is a common occurrence in the Middle East countries. We present a patient with a unique complication of fishbone ingestion. A 65-year-old woman presented with left-sided neck pain and swelling since 5 days before admission. A linear foreign body with horizontal orientation was seen in CT scan at the superior part of the pharynx along with a collection around it which caused a laceration on the medial aspect of internal jugular vein and thrombosis inside the internal jugular vein.

• egd
• esophagus
• eus
• foreign body
• submucosa

• Endoscopy
• Endosonography
• Esophageal Perforation/diagnosis
• Esophageal Perforation/diagnostic imaging
• Esophageal Perforation/surgery
• Foreign Bodies/diagnosis
• Foreign Bodies/diagnostic imaging
• Foreign Bodies/surgery
• Humans
• Male
• Middle Aged
• Tomography, X-Ray Computed

Fish bone foreign body (FFB) is the most frequent food-associated foreign body (FB) in adults, especially in Asia, versus meat in Western countries. The esophageal sphincter is the most common lodging site. Esophageal FB disease tends to occur more frequently in men than in women. The first diagnostic method is laryngoscopic examination. Because simple radiography of the neck has low sensitivity, if perforation or severe complications requiring surgery are expected, computed tomography should be used. The risk factors associated with poor prognosis are long time lapse after FB involvement, bone type, and longer FB (>3 cm). Bleeding and perforation are more common in FFB disease than in other FB diseases. Esophageal FB disease requires urgent treatment within 24 hours. However, FFB disease needs emergent treatment, preferably within 2 hours, and definitely within 6 hours. Esophageal FFB disease usually occurs at the physiological stricture of the esophagus. The aortic arch eminence is the second physiological stricture. If the FB penetrates the esophageal wall, a life-threatening aortoesophageal fistula can develop. Therefore, it is better to consult a thoracic surgeon prior to endoscopic removal.

• Bone and bones
• Esophagus
• Foreign bodies
• Pharynx
• Seafood

Foreign body ingestion rarely causes complications, though it can pose a significant diagnostic challenge. Perforation, particularly of more muscular viscera, can present insidiously with a wide range of differential diagnoses.

Here we present a case of 75 year-old woman presenting with chest and epigastric pain. Initial imaging suggested a pancreatic lesion. Despite appropriate treatment she deteriorated clinically, and following urgent laparotomy a duck bone fragment was found to have perforated the lesser curvature of the stomach and embedded within the liver causing subhepatic abscess formation and associated inflammation.

There are a number of examples of insidious presentations of gastrointestinal perforation. However, we have found only one other case of a perforation presenting as a pancreatic pseudotumour, and ours is the first to have been successfully managed by removal of the foreign body and drainage of the abscess alone.

A high level of suspicion is required to make the correct diagnosis in cases such as these where the symptoms are not clear-cut. Thorough review and discussion of imaging prior to surgical treatment is essential to prevent unnecessary intervention.

• Foreign body
• Perforation