Abdul Ahad Ehsan Sheikh, MD1, Khalid Ahmed, MD2, Beshir Saeed, MD2, Fouzia Oza, MD1, Mladen Jecmenica, MD1 1Wright Center for GME, Scranton, PA; 2Wright Center for Graduate Medical Education, Scranton, PA
Introduction: Foreign body ingestion is a commonly encountered scenario with most of the foreign objects harmlessly passing through the GI tract. Only 1% of the foreign objects have been reported to penetrate the GI tract and lodge in solid organs such as the pancreas or liver. We present a rare case of a linear metallic foreign objective, suggestive of a needle, found in the head of the pancreas.
Case Description/Methods: A 35-year-old gentleman was referred to the GI clinic after abnormal findings on a CT scan. The patient had two CT scans in the last four years due to kidney stones, both showed a 2.1 cm metallic density in the pancreatic head. He reported being completely asymptomatic and had no history of any abdominal surgeries or interventions. Endoscopic ultrasound was performed for further evaluation which showed a hyperechoic linear foreign body in the head of the pancreas close to the ampullary area suggestive of a needle. The rest of the pancreas and the pancreatic duct were otherwise normal without any evidence of pathological lymphadenopathy. Since the patient was asymptomatic for the last many years no further workup was suggested although the patient was given the option of referral to a pancreaticobiliary surgeon which he denied at that time. The patient has since been asymptomatic for the last two years now.
Discussion: A foreign body in the pancreas is an extremely rare entity with about 23 reported cases based on our literature search. The most commonly seen foreign objects are fish bones, needles, or wires. Sharp foreign objects can perforate the walls of the stomach or duodenum and reach solid organs like the liver or pancreas. Another hypothesis is migration through the ampulla of Vater into the pancreatic duct and subsequently into the head of the pancreas through penetration. The end result can cause pancreatitis, pseudoaneurysm, abscess, or remain asymptomatic as evidenced in our case. Various diagnostic modalities can be used including abdominal X-Ray, CT scan, and endoscopic ultrasound like our case. MRCP should be contraindicated due to the possibility of the foreign body being metallic like a needle. Our patient was managed conservatively with serial follow-ups and close monitoring however open surgical extraction and more recently laparoscopic extraction has been used. Although rare, foreign body ingestion can lead to serious complications and thus should always be noted as a differential diagnosis.
Figure: (a & b) : CT scan cross-sectional and coronal view showing 2.1 cm metallic density in the pancreatic head. (c) : Endoscopic ultrasound image showing hyperechoic linear foreign body in the head of the pancreas.
Abdul Ahad Ehsan Sheikh indicated no relevant financial relationships.
Khalid Ahmed indicated no relevant financial relationships.
Beshir Saeed indicated no relevant financial relationships.
Fouzia Oza indicated no relevant financial relationships.
Mladen Jecmenica indicated no relevant financial relationships.
Abdul Ahad Ehsan Sheikh, MD1, Khalid Ahmed, MD2, Beshir Saeed, MD2, Fouzia Oza, MD1, Mladen Jecmenica, MD1. P2194 - Who Left the Needle in the Pancreas?, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.