3 cm of fish bones penetrated the stomach wall and inserted into the pancreas to cause inflammation. Digital navigation helps to uncover the "true culprit"

Fishbone stuck in the throat or even the esophagus is not uncommon in daily life, but it is "long driving down" all the way, passing through the stomach and directly inserting into the pancreas at a special location.
It is not that simple!

Repeated abdominal pain and poor appetite, almost diagnosed as pancreatic cancer

Repeated abdominal pain and poor appetite, almost diagnosed as pancreatic cancer

Ms.
Li, who lives in Nansha, started more than 3 months ago.
Her upper right belly had pain from time to time
.

She had a bad appetite and couldn't eat food.

Ms.
Li was terribly scared.
Later, an enhanced CT scan of the abdomen was performed.
The results showed that the head and body of the pancreas were locally enlarged, and there was a slender, high-density shadow of about 3 cm in the parenchyma of the head of the pancreas.
It is believed that foreign bodies in the pancreas may cause peripancreatic infection and chronic pancreatitis
.

At the local hospital, Ms.

Preoperative CT showed that the fish bone has been inserted into the pancreas

Preoperative CT shows that the fish bone has been inserted into the pancreas .
Preoperative CT shows that the fish bone has been inserted into the pancreas.

Professor Yang Jian, the deputy director of the First Hepatobiliary Department who received the consultation, made detailed consultations and fully understood Ms.
Li’s onset and medical experience, and learned that Ms.
Li is a "fish-eater" and especially likes to eat fish soup with rice.
Information, combined with previous inspection data, preliminary judgment is the symptoms caused by eating fish bones by mistake
.

The results of enhanced CT examination showed that Ms.

3 cm fish bone pierced the stomach wall and inserted into the pancreas to cause a series of symptoms

3 cm fish bone pierced the stomach wall and inserted into the pancreas to cause a series of symptoms

"Under normal circumstances, if a fishbone enters the throat or gastrointestinal tract, it can be removed through a digestive endoscopy
.

However, the pancreas is located in a special and deep position, located behind the stomach and surrounded by the duodenum on the right

Under the guidance of the director of the department, Professor Fang Chihua, Professor Yang Jian’s team used three-dimensional reconstruction software to reconstruct the organs, blood vessels, and blood vessels in her body based on Ms.
Li’s CT image data.

The fish bones are truly restored 1:1, and the relative positional relationship between the fish bones and the pancreas, stomach, liver and surrounding blood vessels is clearly presented in all directions
.

After three-dimensional reconstruction, the relationship between fish bones and surrounding organs is clear at a glance

After three-dimensional reconstruction, the relationship between fish bone and surrounding organs is clear at a glance After three-dimensional reconstruction, the relationship between fish bone and surrounding organs is clear at a glance

Combined with the three-dimensional images, Professor Yang Jian speculated that after the fish bones entered the stomach along the esophagus, the peristaltic action of the stomach caused the fish bones to pierce the back wall of the stomach little by little.
This is the pain in the upper right abdomen of Ms.
Li at the beginning, especially after eating.
The reason why the meal is more painful
.

Later, because the fish bone pierced the back wall of the stomach to reach the pancreas, the symptoms of abdominal pain and poor appetite improved slightly

"The 3 cm long fish bone entering the head of the pancreas caused an abscess of the pancreatic head, which in turn caused the occlusion of the superior mesenteric vein and the splenic vein, leading to spongy changes in the portal vein and regional portal hypertension
.

If the foreign body is not removed in time, The condition will further aggravate and may even lead to serious complications such as gastrointestinal bleeding and pancreatic malignant transformation

Augmented reality navigation helps uncover the "lurking" fish bones

Augmented reality navigation helps uncover the "lurking" fish bones

However, many problems of the operation are also in front of Professor Yang Jian’s team: The long-term inflammation around the head of the pancreas may lead to intra-abdominal adhesions, and the risk of surgical bleeding is high; the fish bones have completely entered the pancreatic parenchyma, invisible and intangible.
This leads to difficulty in positioning; the surrounding blood vessels have cavernous degeneration, forming varicose vascular clusters, which not only reduces the operating space, but also increases the risk of bleeding
.

After detailed preoperative evaluation and department discussion, Professor Fang Chihua and Professor Yang Jian jointly formulated a precise preoperative plan for laparoscopic foreign body removal and gastric repair on the three-dimensional model
.

Recently, the operation was held as scheduled
.

Professor Yang Jian concentrated his energies step by step carefully, and finally reached the pancreas head position

At this time, intraoperative ultrasound and intraoperative augmented reality navigation technology played a powerful role
.

Through precise positioning and navigation, the surgical team quickly found the fish bones and removed them completely

Intraoperative ultrasound and augmented reality technology for precise navigation and positioning

Intraoperative ultrasound and augmented reality technology for precise navigation and positioningIntraoperative ultrasound and augmented reality technology for precise navigation and positioning

Director Yang Jian's team is in operation

Director Yang Jian's team is in operation.
Director Yang Jian's team is in operation.

The fish bones removed by surgery are up to 3 cm long

The fish bone removed by surgery is up to 3 cm long The fish bone removed by surgery is up to 3 cm long

After careful postoperative care, Ms.
Li recovered well and was discharged from the hospital on the 5th day after surgery
.

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