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An unusual cause of epigastric pain: a fishbone stuck in the duodenum

A 56-year-old woman presented with epigastric pain for 5 days after eating fish. She had no history of any disease or medication. Her vital signs were normal. On examination, the epigastric region was tender. No abnormalities were found in the laboratory tests. Abdominal ultrasonography was normal. Endoscopy showed a fishbone stuck in second part of the duodenum (Figure 1). The oesophagus and stomach were unremarkable. Approximately 2 cm in length, the fishbone was removed using standard grasping forceps. The patient's pain dramatically improved immediately after removing the fishbone and she was stable in follow up. 
 
 
 
Figure 1 
 
Endoscopic image of fishbone stuck in the second part of the duodenum 
 
 
 
Fishbones are the most often ingested foreign bodies that become impacted in the upper gastrointestinal tract. Most foreign bodies generally pass spontaneously through the gastrointestinal tract. However, A minority of patients require endoscopic removal and surgical intervention [1, 2]. To the best of our knowledge, this is the first reported case of a stuck fishbone successfully removed from the duodenum with dramatic improvement immediately afterwards.