Taha R, Elsayed G, Mohamed L, Gadour E. Beyond biliary causes, fish bone perforation as a rare etiology of recurrent fever in a post-Whipple patient: A case report. World J Clin Cases 2025; 13(36): 114956 [DOI: 10.12998/wjcc.v13.i36.114956]
Corresponding Author of This Article
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. eyadgadour@doctors.org.uk
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Gastroenterology & Hepatology
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Case Report
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 26, 2025 (publication date) through Dec 25, 2025
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World Journal of Clinical Cases
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2307-8960
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Taha R, Elsayed G, Mohamed L, Gadour E. Beyond biliary causes, fish bone perforation as a rare etiology of recurrent fever in a post-Whipple patient: A case report. World J Clin Cases 2025; 13(36): 114956 [DOI: 10.12998/wjcc.v13.i36.114956]
World J Clin Cases. Dec 26, 2025; 13(36): 114956 Published online Dec 26, 2025. doi: 10.12998/wjcc.v13.i36.114956
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
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.
Author contributions: Elsayed G and Gadour E contributed to conceptualization, radiological analysis, image interpretation, and manuscript editing; Taha R and Mohamed L contributed to data collection; Gadour E contributed to manuscript writing, and revision; Elsayed G contributed to clinical management, data interpretation; all authors have reviewed and agreed with the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
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. eyadgadour@doctors.org.uk
Received: October 11, 2025 Revised: October 30, 2025 Accepted: December 11, 2025 Published online: December 26, 2025 Processing time: 84 Days and 0.2 Hours
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 re-evaluation 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 anatomy after Whipple procedure. Critical image review and advanced enteroscopic techniques are invaluable for diagnosing obscure causes in complex cases.
Core Tip: This case highlights the importance of considering atypical causes like gastrointestinal foreign body perforation in patients with altered postoperative anatomy presenting with recurrent fever and abdominal pain. Despite extensive workup, the cause remained elusive until deep push enteroscopy identified an embedded fish bone in the efferent jejunal limb of a post-Whipple patient. This was only possible after a thorough review of the computed tomography imaging, which showed a subtle linear hyperdensity. This case demonstrates the value of critical image review and advanced endoscopic techniques in diagnosing obscure gastrointestinal pathology in complex post-surgical patients.
