Migration of bird feather into bile duct mimicking bile duct stone recurrence: First-ever case report

The presence of a bird feather as a foreign object inside the human body has rarely been reported in the literature. A feather can cause severe complications such as neck infection or duodenal perforation. Early recognition and treatment of this condition may prevent associated morbidity and mortality. We report a case of a female patient who had a feather inside her bile duct. The feather caused abdominal pain without acute cholangitis. Fortunately, it was successfully removed before causing severe complications. This is the first-ever case report of the migration of a feather into the common bile duct. A 54-year-old Taiwanese woman had a history of cholecystectomy due to acute calculous cholecystitis 1 year prior to this visit. She had also undergone endoscopic retrograde cholangiopancreatography (ERCP) two times due to acute cholangitis (8 years ago and 1 year ago). Endoscopic papilla sphincterotomy had been performed during ERCP for stone extraction. This time, she visited our clinic due to intermittent epigastric pain for 2 weeks. There were no signs of acute cholangitis. Abdominal computed tomography (CT) did not reveal bile duct stone or foreign bodies. ERCP was arranged for possible hidden stones not detected by CT. To our surprise, we pulled a 5-cm-long bird feather out of her bile duct during ERCP. After successfully removing the feather, she remained free of abdominal pain and other complications during the next 6 months of follow-up at our outpatient clinic. Migration of foreign bodies into the bile duct should be included in the differential diagnosis for unexplained abdominal pain in patients with choledochoduodenal fistula due to previous endoscopic papilla sphincterotomy.