Fish Bone Penetrating into the Head of Pancreas in a Patient with Billroth II Gastrojejunostomy

A 76-year-old male patient with a history of abdominal aortic aneurysm repair and Billroth II gastrojejunostomy (25 years ago) for refractory peptic ulcer disease presented with gradually worsening epigastric pain over the past 48 h, without any associated fever. An abdominal computerized tomography demonstrated a radiopaque foreign body penetrating into the pancreatic head, with the proximal portion partially residing in the duodenal lumen (Fig. 1). The snare’s plastic sheath was left 2–3 cm distal to the tip of the endoscope to allow alignment of the fish bone’s long axis with the axis of the lumen and the endoscope. Since the appropriate alignment was successfully achieved, an overtubeovertube was not used.