Endoscopic Ultrasound-Guided Removal of Grill Wire Bristle in Pancreatic Head.

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CASE REPORT A 56-year-old man presented with diverticulitis and was successfully treated with antibiotics. Interestingly, abdominal computed tomography revealed an incidental finding of a 19-mm linear radiodensity in the head of the pancreas extending to the medial wall of the duodenum proximal to the ampulla and possibly extending intraluminally with no associated inflammatory changes (Figure 1). Laboratory data did not indicate signs of pancreatic inflammation (lipase 27 U/L [7–60]). Standard upper endoscopy with a forward-viewing gastroscope found no metallic object or endoscopically visible abnormalities in the duodenal wall. Endoscopic ultrasound demonstrated an 18-mm linear, hyperechoic lesion in the proximal second portion of the duodenum piercing into the head of the pancreas (Figure 2). A duodenoscope was then advanced to the same position as the echoendoscope and allowed the visualization of a small erythematous area in the duodenal wall with a black dot, which was not visualized during standard upper endoscopy. The black dot was grasped with cold biopsy forceps, leading to the extraction of a grill brush wire bristle (Figures 3 and 4). The patient was discharged without any complications.Figure 1.: Abdominal computed tomography showing a 19-mm linear radiodensity (white arrows) in the region of the head of the pancreas with no associated inflammatory changes.Figure 2.: Endoscopic ultrasound demonstrating an 18-mm long, linear, hyperechoic lesion (white arrow) in the proximal second portion of the duodenum, piercing through the duodenal wall into the head of the pancreas.Figure 3.: A duodenoscope visualizing a small erythematous area (white arrow) with a black dot in the center representing the end of the grill brush wire bristle.Figure 4.: Grill brush wire bristle after extraction.Accidental grill brush wire bristle ingestion has increased over the past decade. It occurs more frequently in the summer with symptoms and injury to the oropharynx with rare instances of migration more distally. The patient was referred for endoscopic ultrasound to remove this linear object that was lodged in the head of the pancreas as seen on computed tomography. Although he was asymptomatic, there remained a concern that the object could migrate further into the pancreas and potentially cause issues. To our knowledge, this is the first report of a grill brush wire bristle migrating down the gastrointestinal tract and perforating into the pancreatic head. DISCLOSURES Author contributions: A. Canakis wrote and edited the article. LS Lee edited and approved the final article and is the article guarantor. Financial disclosures: None to report. Informed patient consent was obtained for this case report.