Upper Abdominal Pain Following Endoscopic Ultrasound-Guided Pancreatic Biopsy
A 56-year-old female patient was referred to our department for an evaluation of abdominal pain and a pancreatic mass suspicious for a malignant neoplasm. Two endoscopic ultrasound-guided fine needle aspiration biopsies (EUS-FNB) of the pancreatic mass had already been performed at another center and had failed to yield diagnostic findings. The patient had been experiencing strong upper abdominal pain ever since. Sagittal reformation of contrast-enhanced abdominal computed tomography (Figure 1) showed a radiopaque, elongated foreign body protruding from the pancreas (P) into the duodenal lumen (D). The gastroscopy performed in a first step prior to repeat endoscopic ultrasound revealed the cause of persistent pain correlating to this: an approximately 8-cm long fragment of an EUS biopsy needle was piercing the duodenal mucosa (Figure 2). Following endoscopic removal of the needle using a gripping forceps, the pancreatic carcinoma was histologically confirmed by means of repeat EUS-FNB. The upper abdominal pain significantly improved following removal of the foreign body. Conclusion: In rare cases, particularly under extreme mechanical stress, EUS-FNB. needles can fracture and fragments of the needle be left behind in the puncture area. Therefore, one should always check that the needle is intact following puncture.
Nina Böhling, Prof. Dr. med. Christian P. Strassburg, PD Dr. med. Tobias J. Weismüller, Medizinische Klinik und Poliklinik I, Universitätsklinikum Bonn
Conflict of interest statement: The authors declare that no conflict of interest exists.
Translated from the original German by Christine Rye.
Cite this as: Böhling N, Strassburg CP, Weismüller TJ: Upper abdominal pain following endoscopic ultrasound-guided pancreatic biopsy. Dtsch Arztebl Int 2021; 118: 461. DOI: 10.3238/arztebl.m2021.0105