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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. ",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/beyond-biliary-causes-fish-bone-perforation-as-a-rare-etiology-of-recurrent-fever-in-a-post-whipple-patient-a-case-report/406804/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/beyond-biliary-causes-fish-bone-perforation-as-a-rare-etiology-of-recurrent-fever-in-a-post-whipple-patient-a-case-report/406804.png","ImageObject",300,407,{"name":42,"@type":43},"Guten tag","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-06","2026-09-28",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",6,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What rare cause of recurrent fever is reported in a post-Whipple patient?","Question",{"text":63,"@type":64},"Fish bone-induced jejunal perforation is reported as a rare non-biliary etiology of recurrent fever and abdominal pain after a Whipple procedure.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"Why was the diagnosis initially difficult?",{"text":68,"@type":64},"An extensive initial workup with imaging and laboratory tests was inconclusive, and subtle CT findings were challenging to interpret while symptoms mimicked cholangitis.",{"name":70,"@type":61,"acceptedAnswer":71},"How was the embedded fish bone ultimately identified and treated?",{"text":72,"@type":64},"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.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},406804,1790983250,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,105,109,114,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":102,"show_sort_weight":103,"slug":104},"Technology",50,"technology",{"id":106,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":107,"slug":108},7,40,"healthcare",{"id":110,"doc_module":4,"doc_module_name":25,"category_name":111,"show_sort_weight":112,"slug":113},8,"Research & Report",30,"research-report",{"id":115,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},9,"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":97,"slug":129},19,"General","general",{"code":4,"msg":82,"data":131},{"doc_id":79,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":106,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":106,"language":139,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":12,"update_tm":143,"read_time":144,"preview_page_count":4},687212321768,"https://ap-avatar.wpscdn.com/avatar/a0010bdbe886d2fe77?x-image-process=image/resize,m_fixed,w_180,h_180&k=1789897067658708522","| W | J | C | C | World Journal of\u003Cbr>Clinical Cases |\n| --- | --- | --- | --- | --- |\n\nSubmit a Manuscript: [https://www.f6publishing.com](https://www.f6publishing.com) World J Clin Cases 2025 December 26; 13(36): 114956  \nDOI: 10.12998/wjcc.v13.i36.114956 ISSN 2307-8960 (online)  \nCASE REPORT  \nBeyond biliary causes, fish bone perforation as a rare etiology of recurrent fever in a post-Whipple patient: A case report  \nRama Taha, Ghassan Elsayed, Lama Mohamed, Eyad Gadour  \nSpecialty type: Medicine, research and experimental  \nProvenance and peer review:  \nUnsolicited article; Externally peer reviewed.  \nPeer-review model: Single blind  \nPeer-review report’s classification Scientific Quality: Grade B, Grade C  \nNovelty: Grade A, Grade B  \nCreativity or Innovation: Grade B, Grade B  \nScientific Significance: Grade A, Grade A  \nP-Reviewer: Zharikov YO, MD, PhD, Associate Professor, Russia  \nReceived: October 11, 2025  \nRevised: October 30, 2025  \nAccepted: December 11, 2025  \nPublished online: December 26, 2025  \nProcessing time: 84 Days and 1.8 Hours  \nRama Taha, Ghassan Elsayed, Lama Mohamed, Department of Gastroenterology, Mediclinic Middle East Hospital, Abu Dhabi W67, United Arab Emirates  \nEyad Gadour, Multiorgan Transplant Centre of Excellence, Liver Transplantation Unit, King Fahad Specialist Hospital, Dammam 32253, Saudi Arabia  \nEyad Gadour, Internal Medicine, Faculty of Medicine, Zamzam University College, Khartoum 11113, Sudan  \nCo-first authors: Rama Taha and Ghassan Elsayed.  \nCorresponding 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)  \nAbstract  \nBACKGROUND  \nPatients 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.  \nCASE SUMMARY  \nA 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.  \nCONCLUSION  \nClinicians should consider gastrointestinal foreign body perforation in the differential diagnosis of recurrent fever and abdominal pain in patients with altered  \n WJCC  [https://www.wjgnet.com](https://www.wjgnet.com) 1 December 26, 2025  Volume 13  Issue 36   \nTaha R et al. Recurrent cholangitis due to fish bone perforation  \nanatomy after Whipple procedure. Critical image review and advanced enteroscopic techniques are invaluable for diagnosing obscure causes in complex cases.  \nKey Words: Pancreaticoduodenectomy; Fish bone perforation; Cholangitis; Post-surgical complications; Case report  \n©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.  \nCore 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","cbCaim4p2pcbPBUS","https://ap.wps.com/l/cbCaim4p2pcbPBUS","pdf",2751723,"English","# Abstract\n## Background\n## Case Summary\n## Conclusion\n# Introduction\n## Post-Whipple late complications\n## Diagnostic challenges and management approaches\n# Case Report Content\n## Clinical presentation and workup","[{\"question\":\"What rare cause of recurrent fever is reported in a post-Whipple patient?\",\"answer\":\"Fish bone-induced jejunal perforation is reported as a rare non-biliary etiology of recurrent fever and abdominal pain after a Whipple procedure.\"},{\"question\":\"Why was the diagnosis initially difficult?\",\"answer\":\"An extensive initial workup with imaging and laboratory tests was inconclusive, and subtle CT findings were challenging to interpret while symptoms mimicked cholangitis.\"},{\"question\":\"How was the embedded fish bone ultimately identified and treated?\",\"answer\":\"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.\"}]","Beyond biliary causes, fish bone perforation as a rare etiology of recurrent fever in a post-Whipple patient - A case report | PDF",1790567948,18]