Beyond biliary causes, fish bone perforation as a rare etiology of recurrent fever in a post-Whipple patient - A case report

Sep 28, 2026

Pancreaticoduodenectomy (Whipple procedure) is associated with complex late complications that can be diagnostically challenging, especially when recurrent symptoms resemble biliary disorders. This case report describes a rare non-biliary cause of recurrent fever and abdominal pain: fish bone-induced jejunal perforation in a post-Whipple patient. Extensive initial workup was inconclusive until careful CT image reassessment identified subtle linear hyperdensity and deep push enteroscopy detected an embedded fish bone in the efferent jejunal limb, removed endoscopically.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Abstract

Background

Case Summary

Conclusion

Introduction

Post-Whipple late complications

Diagnostic challenges and management approaches

Case Report Content

Clinical presentation and workup

| W | J | C | C | World Journal of
Clinical Cases | | --- | --- | --- | --- | --- | Submit a Manuscript: [https://www.f6publishing.com](https://www.f6publishing.com) World J Clin Cases 2025 December 26; 13(36): 114956 DOI: 10.12998/wjcc.v13.i36.114956 ISSN 2307-8960 (online) CASE REPORT Beyond biliary causes, fish bone perforation as a rare etiology of recurrent fever in a post-Whipple patient: A case report Rama Taha, Ghassan Elsayed, Lama Mohamed, Eyad Gadour Specialty type: Medicine, research and experimental Provenance and peer review: Unsolicited article; Externally peer reviewed. Peer-review model: Single blind Peer-review report’s classification Scientific Quality: Grade B, Grade C Novelty: Grade A, Grade B Creativity or Innovation: Grade B, Grade B Scientific Significance: Grade A, Grade A P-Reviewer: Zharikov YO, MD, PhD, Associate Professor, Russia Received: October 11, 2025 Revised: October 30, 2025 Accepted: December 11, 2025 Published online: December 26, 2025 Processing time: 84 Days and 1.8 Hours Rama Taha, Ghassan Elsayed, Lama Mohamed, Department of Gastroenterology, Mediclinic Middle East Hospital, Abu Dhabi W67, United Arab Emirates Eyad Gadour, Multiorgan Transplant Centre of Excellence, Liver Transplantation Unit, King Fahad Specialist Hospital, Dammam 32253, Saudi Arabia Eyad Gadour, Internal Medicine, Faculty of Medicine, Zamzam University College, Khartoum 11113, Sudan Co-first authors: Rama Taha and Ghassan Elsayed. Corresponding author: Eyad Gadour, CCST, Consultant, FACP, FRCP, Professor, Multiorgan Transplant Centre of Excellence, Liver Transplantation Unit, King Fahad Specialist Hospital, Ammar Bin Thabit Street, Dammam 32253, [Saudi Arabia.](Saudi Arabia. eyadgadour@doctors.org.uk)[ eyadgadour@doctors.org.uk](Saudi Arabia. eyadgadour@doctors.org.uk) 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 reevaluation 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 WJCC [https://www.wjgnet.com](https://www.wjgnet.com) 1 December 26, 2025 Volume 13 Issue 36 Taha R et al. Recurrent cholangitis due to fish bone perforation anatomy after Whipple procedure. Critical image review and advanced enteroscopic techniques are invaluable for diagnosing obscure causes in complex cases. Key Words: Pancreaticoduodenectomy; Fish bone perforation; Cholangitis; Post-surgical complications; Case report ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved. Core Tip: This case highlights the importance of considering atypical causes like gastrointestinal foreign body perforation inpatients with altered postoperative anatomy presenting with recurrent fever and a

FAQs

What rare cause of recurrent fever is reported in a post-Whipple patient?

Fish bone-induced jejunal perforation is reported as a rare non-biliary etiology of recurrent fever and abdominal pain after a Whipple procedure.

Why was the diagnosis initially difficult?

An extensive initial workup with imaging and laboratory tests was inconclusive, and subtle CT findings were challenging to interpret while symptoms mimicked cholangitis.

How was the embedded fish bone ultimately identified and treated?

Careful reevaluation of computed tomography revealed subtle linear hyperdensity, and deep push enteroscopy identified an embedded fish bone in the efferent jejunal limb, which was removed endoscopically.

Sep 28, 2026

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