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This article retrospectively analyzes an 89-year-old male case with secondary choledocholithiasis triggered by fish bones and reviews the literature using PubMed search terms related to foreign body cases and common bile duct stones. Patient demographics, foreign body origins, clinical presentation, treatments, and outcomes are synthesized to inform management. The review emphasizes considering biliary complications after cholecystectomy or ingestion, preferential ERCP, and alternative strategies when ERCP fails.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/secondary-choledocholithiasis-caused-by-fish-bones-a-case-report-and-review-of-the-literature/446500/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/secondary-choledocholithiasis-caused-by-fish-bones-a-case-report-and-review-of-the-literature/446500.png","ImageObject",300,407,{"name":92,"@type":93},"McQueen","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-02","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why can fish bones lead to secondary choledocholithiasis?","Question",{"text":112,"@type":113},"Foreign bodies in the common bile duct can serve as a nidus for stone formation, resulting in secondary choledocholithiasis. Fish bones migrating or remaining in the biliary tract can contribute to this process.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What diagnostic and management approach is emphasized for biliary foreign bodies?",{"text":117,"@type":113},"Biliary foreign bodies often present similarly to choledocholithiasis, so the possibility should be considered in patients with typical symptoms years after procedures or ingestion. Endoscopic retrograde cholangiopancreatography is presented as the preferred treatment, with further steps if it fails.",{"name":119,"@type":110,"acceptedAnswer":120},"What does the paper suggest when ERCP does not work?",{"text":121,"@type":113},"When ERCP fails, repeating ERCP or converting to surgery should be considered. 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Journal of Medical Case Reports (2026) 20:7  \n[https://doi.org/10.1186/s13256-025-05705-1](https://doi.org/10.1186/s13256-025-05705-1)  \nJournal of Medical Case Reports  \n CASE REPORT Open Access  \nSecondary choledocholithiasis caused by fish bones: a case report and review of the literature  \nLuyao Zhang1†, Jingbang Huang1†, Qinyue Liu2†, Chaonong Cai1* and Peiping Li 1*  \nAbstract  \nBackground Foreign body in the common bile duct can act as a nidus for stone formation, leading to secondary choledocholithiasis. Currently there are very few reviews concerning biliary stones caused by foreign bodies; this article may offer some help for relevant situations.  \nCase presentation We retrospectively analyzed the case of an 89-year-old Chinese (Han ethnicity, Asian) male patient with secondary choledocholithiasis caused by fish bones. We also present a review of the literature regarding choledocholithiasis caused by foreign bodies using “foreign body case” and “common bile duct stone”  \nas the search terms in the PubMed database. The analysis of patient demographics, foreign body origins, clinical presentations, treatments, and outcomes may provide some suggestions for the management of those specific biliary foreign body cases.  \nConclusion Even years after cholecystectomy, endoscopic retrograde cholangiopancreatography, or foreign body ingestion, biliary complications secondary to foreign body migration should still be considered. The clinical presentation of most biliary foreign bodies is similar to choledocholithiasis. endoscopic retrograde cholangiopancreatography can serve as the preferred treatment modality. When endoscopic retrograde cholangiopancreatography fails, repeating endoscopic retrograde cholangiopancreatography or conversion to surgery should be considered.  \nKeywords Acute cholangitis, Choledocholithiasis, Common bile duct, Foreign body  \n†Luyao Zhang, Jingbang Huang, and Qinyue Liu contributed equally to this work.  \n*Correspondence: Chaonong Cai[caichn@mail.sysu.edu.cn](caichn@mail.sysu.edu.cn)[ ](caichn@mail.sysu.edu.cn)Peiping Li [Lipp8@mail.sysu.edu.cn](Lipp8@mail.sysu.edu.cn)  \n1 Department of Hepatobiliary Surgery and Liver Transplantation, The Fifth Affiliated Hospital of Sun Yat-Sen University, 52 Mei Hua East Road, Zhuhai, Guangdong, China  \n2 Centro Hospitalar Conde de São Januário, Estrada do Visconde de São Januário, Macau, China  \nBackground  \nThe incidence of gallstones is about 15% [1]. Among patients with cholelithiasis, 10–20% are found to have concomitant choledocholithiasis [2, 3]. Choledocholithiasis is a common digestive system disease. When causing biliary stenosis, it can lead to acute cholangitis, a lifethreatening complication [4]. Mortality risk is high if the condition is not treated with antibiotic therapy and biliary pressure is not immediately reduced using appropriate methods [5].  \nThere are many factors contributing to the formation ofcholedocholithiasis. In the presence of conditions such as biliary tract infection, bile stasis, or biliary ascariasis, the calculus in the common bile duct (CBD) may originate from the bile duct system, known as the primary stones  \n© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licenc","cbCaimFEUnuq28dd","https://ap.wps.com/l/cbCaimFEUnuq28dd","pdf",1513513,"English","# Abstract\n# Background\n# Case presentation\n## Literature review search strategy\n# Conclusion\n# Keywords\n# References and clinical context","[{\"question\":\"Why can fish bones lead to secondary choledocholithiasis?\",\"answer\":\"Foreign bodies in the common bile duct can serve as a nidus for stone formation, resulting in secondary choledocholithiasis. Fish bones migrating or remaining in the biliary tract can contribute to this process.\"},{\"question\":\"What diagnostic and management approach is emphasized for biliary foreign bodies?\",\"answer\":\"Biliary foreign bodies often present similarly to choledocholithiasis, so the possibility should be considered in patients with typical symptoms years after procedures or ingestion. Endoscopic retrograde cholangiopancreatography is presented as the preferred treatment, with further steps if it fails.\"},{\"question\":\"What does the paper suggest when ERCP does not work?\",\"answer\":\"When ERCP fails, repeating ERCP or converting to surgery should be considered. This guidance is drawn from the reviewed clinical course and management outcomes.\"}]","Secondary choledocholithiasis caused by fish bones - a case report and review of the literature | PDF",1790715628]