Protrusion of a migrated fish bone in the neck

Unusual Intraspinal Migration of Ingested Foreign Body

BACKGROUND

Accidental foreign body ingestion is a common occurrence; however, extraluminal migration is uncommon. We report for the first time in the literature an unusual migration of an ingested foreign body into the spinal canal through the vertebral body and discuss its possible route of migration.

CASE DESCRIPTION

A 38-year-old man presented with throat pain after eating chicken fried rice. Esophagoscopy was normal. A cervical spine radiograph and computed tomography scan showed the presence of a thin, radiopaque foreign body coursing through the C5 vertebral body and entering the spinal canal. We explored the neck and removed a 3-cm-long copper wire (foreign body).

CONCLUSIONS

Type, size, and shape of the foreign body determine the course of foreign body migration. A possible route of foreign body migration into the spinal canal is the Hahn canal and basivertebral foramina.

An Unusual Neck Mass: Ingested Chicken Bone

BACKGROUND

Foreign bodies in the upper aerodigestive tract are frequently seen in otolaryngological practice, but migration of an ingested foreign body to the neck is a very rare condition.

CASE REPORT

We present a 66-year-old woman admitted to our outpatient department with a painful neck mass. She had a history of emergency department admission 4 months prior with odynophagia after eating chicken meal. A physical examination revealed a painful and hyperemic mass on the left neck. Antibiotherapy did not relieve the patient's symptoms and signs. A 3-cm linear foreign body was observed in X-ray and computed tomography scans. The symptoms of the patient were relieved after excision of the foreign body.

CONCLUSION

Although it is a rare situation, migration of a foreign body ingested through the aerodigestive tract to the neck should be kept in mind in the differential diagnosis of patients who present with neck masses.

Thoracic spinal epidural abscess caused by fishbone perforation: A case report and review of literature

RATIONALE

Ingestion of a fishbone is a common cause of esophageal injury, but spinal epidural abscess (SEA) is a rare condition due to the esophageal penetration by a swallowed fishbone. Prompt diagnosis can be seldom made owing to incomplete patient history taking and difficulties in imaging evidence identification.

PATIENT CONCERNS

We describe the case of a 62-year-old woman who was stuck in her throat by a fishbone, and complained of back pain, paresis of the lower limbs and fever, successively. To our knowledge, this is the first case report that we know of thoracic SEA caused by fishbone perforation.

DIAGNOSES

About 20 days after the onset of severe back pain, she was diagnosed with SEA based on the clinical presentation and imaging findings.

INTERVENTIONS

Antibiotic therapy and rehabilitation therapy were carried out afterwards. However, due to exacerbation of her condition, surgical intervention had to be taken eventually.

OUTCOMES

It is quite unfortunate for this patient to have a poor prognosis due to a delayed diagnosis and an improper management.

LESSONS

A number of lessons can be learnt from this case.

The predictive role of dual source CT for esophageal foreign bodies

INTRODUCTION

Esophageal foreign bodies can be a danger to a patient's life. Flexible or rigid endoscopy is a commonly used type of invasive investigation for these, and radiological examinations are also useful.

STUDY DESIGN

Series of reports.

METHODS AND RESULTS

Multi-slice spiral CT (MSCT) can confirm and locate most foreign bodies. Dual source CT (DSCT) is a more advanced technique with double speed, 20% of the radiation dosage and higher resolution, so it is more suitable for possible esophageal foreign bodies, especially in children, with no need for sedation. We provide a preliminary experiment of a DSCT scan of two fish, and we present a series of 11 cases with DSCT scans of which 5 were positive.

CONCLUSIONS

Timely diagnosis and accurate localization are paramount for endoscopy. DSCT is very useful for diagnosis and evaluation of esophageal foreign bodies.

Migrated pharyngeal fish bone causing spondylodiscitis. Case report

Ingestion of foreign bodies is a common problem seen at emergency rooms and frequently involves chicken and fish bones. There are few cases of migrated foreign bodies through the retropharynx causing infectious process in the area but no one, despite the proximity, causing spondylodiscitis. Perhaps such condition is attributed to the integrity of the longus colli fascia covering and protecting the cervical spine. We described the first case of spondylodiscitis due to a foreign body (saw-toothed fish bone) that penetrated the longus colli fascia and carved into vertebral body C3.

Foreign body impaction of the vertebral canal

Foreign body impactions in the aerodigestive tract are common, but have the potential for serious complications. A foreign body may disrupt the mucosal lining and migrate regionally thereby risking impingement or injury to critical neurovascular structures in the cervical region. It is important to recognize potential complications that may arise from luminal compromise. In such cases, expeditious surgical treatment is warranted.

Role of imaging in the assessment of impacted foreign bodies in the hypopharynx and cervical esophagus

Impaction of foreign bodies in the upper digestive tract is a serious pathologic condition in ear, nose, and throat practice and is particularly common in children, prisoners, and psychiatric patients. Commonly found objects include fish bones, chicken bones, pieces of glass, dental prostheses, coins, and needles. The goals of the initial patient assessment are to identify the type of object, its location in the gastrointestinal tract, the presence of any associated complications, and the presence of any underlying esophageal conditions. Radiographic evaluation is helpful to confirm the location of foreign bodies and associated complications. Plain films of the neck and chest commonly will show the location of radiopaque objects, such as coins. Both anteroposterior and lateral views are necessary, as some radiopaque objects overlying the vertebral column may only be visible on the lateral view. Multidetector row computed tomography is superior to plain radiographs for the detection of pharyngoesophageal foreign bodies and provide additional crucial information for the management of complicated cases especially related to sharp or pointed ingested foreign bodies.

Iatrogenic migration of an impacted pharyngeal foreign body of the hypopharynx to the prevertebral space

Impaction of foreign bodies in the upper aerodigestive tract is commonly encountered in ENT practice. The present paper describes an iatrogenic complication with migration of an impacted foreign body (chicken bone) of the hypopharynx into the prevertebral space, after unsuccessful attempt of endoscopic removal. The foreign body was visualized with cervical CT scan lying extraluminally between the major vessels of the neck. An open surgical procedure with neck exploration was necessary for the definite treatment.