S6158 The Mystery Bone: Unrecalled Foreign Body Causing Right Upper Quadrant Pain Post-Sleeve Gastrectomy

Introduction: Foreign body (FB) ingestion in adults without recollection is rare, especially in those with altered gastrointestinal anatomy such as post–sleeve gastrectomy (SG) patients. These cases present diagnostic challenges and are prone to delayed recognition. Persistent symptoms in such patients warrant careful evaluation and repeat imaging to avoid serious complications. Case Description/Methods: A 57-year-old woman with a history of SG 4 years prior presented with 2 weeks of persistent right upper quadrant (RUQ) abdominal pain. The pain began with diarrhea, which resolved, and she denied nausea, vomiting, or chills. The pain worsened when lying flat and improved with upright positioning. Initial computed tomography imaging at an outside hospital revealed a hiatal hernia with gastritis. Despite this, her pain intensified, prompting further evaluation. Repeat imaging identified a foreign body—suspected to be a bone fragment—lodged in the fourth portion of the duodenum, with surrounding inflammation concerning for microperforation. The patient denied ingesting any foreign material and specifically denied recent chicken consumption. Physical exam showed increasing RUQ tenderness, low-grade fever, and leukocytosis, suggesting worsening inflammation. GI was consulted for urgent evaluation. Small bowel enteroscopy confirmed a sharp FB embedded in the distal duodenum. It was successfully removed using large-capacity forceps and a protective hood. Following removal, the patient’s symptoms resolved, and her clinical condition stabilized. Discussion: This case illustrates the complexity of diagnosing FB ingestion in adults with altered GI anatomy. Post-SG patients may present with vague or atypical symptoms, and the absence of an ingestion history can delay diagnosis. Persistent unexplained abdominal pain in this population should prompt further imaging, even after an initially unremarkable workup. The identification of a bone fragment causing microperforation underscores the importance of maintaining a high index of suspicion. Early endoscopic intervention enabled prompt treatment, avoided surgical complications, and led to full recovery. In post-bariatric patients with persistent abdominal symptoms, FB ingestion should remain on the differential—even without patient recollection.