# Migration of Fish Bones to the Bile Duct Following Hepaticojejunostomy

## TL;DR

Fish bones can migrate to the bile duct after certain surgeries, causing issues that can be safely treated with endoscopic procedures.

## Contribution

This study characterizes fish bone migration into the bile duct following hepaticojejunostomy and evaluates endoscopic treatment outcomes.

## Key findings

- 11 patients with fish bone migration in the bile duct were successfully treated with endoscopic removal.
- Computed tomography reliably detected fish bones as high-density structures in the bile duct.
- Single-balloon enteroscopy was effective for removing fish bones and associated biliary stones.

## Abstract

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.