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Ouyang T, Shi H, Wang Y. Ensuring that ingested fishbones that migrate to the neck are located, diagnosed, and removed early. Eur Arch Otorhinolaryngol 2024; 281:3755-3761. [PMID: 38625558 DOI: 10.1007/s00405-024-08625-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/17/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVES The aim of this retrospective study was to explore the clinical characteristics of and diagnostic and therapeutic strategies for the removal of fish bones that migrate to the neck. METHODS We reviewed the clinical data of 30 patients over the past 12 years who underwent neck surgery in our otorhinolaryngology department for the migration of fish bones from the throat. The location of fish bones and the positivity rate of different examination methods (neck CT and B-ultrasound) were evaluated statistically. The diagnosis and treatment strategy for fish bone migration to the neck was also summarized. RESULTS A total of 24 patients had a history of foreign body ingestion. The duration from foreign body ingestion to the appearance of symptoms in the neck ranged from 26 to 151 days, with a median of 50 days (interquartile range, 32-86 days). Among the 24 patients with fish bones located in the front or side of the neck, 50% (12/24) and 100% (24/24) of whom had positive neck CT and B-ultrasound results, respectively. Additionally, for 6 patients with fish bones in the retropharyngeal space, the positive rate for neck CT was 100%, whereas neck B-ultrasound showed negative results due to the air and depth in the trachea and esophagus. A strong correlation was observed between the length of fish bones detected by B-ultrasound and CT and the actual length. Indeed, no significant difference was observed between the length of fish bone determined by B-ultrasound and the actual length. In patients with fish bones located in the anterior and lateral neck regions, the foreign bodies were successfully removed by a lateral cervical approach operation (23/24). For the 6 cases with fish bones located in the retropharyngeal space, all (6/6) were removed by incising the posterior pharyngeal wall with assistance from transoral endoscopy. CONCLUSIONS The techniques of B-ultrasound and CT have advantages for the diagnosis of migratory foreign bodies in the neck. Although B-ultrasound is more accurate for estimating the length of migratory fish bones in the neck, a combination of both methods can improve the preoperative positive rate of diagnosis. Therefore, a variety of surgical approaches should be employed to manage the different locations of cervical foreign bodies.
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Affiliation(s)
- Tianbin Ouyang
- Department of Otorhinolaryngology, The First Affiliated Hospital of Ningbo University, Ningbo, 315000, Zhejiang, China.
| | - Hou Shi
- Department of Otorhinolaryngology, The First Affiliated Hospital of Ningbo University, Ningbo, 315000, Zhejiang, China
| | - Yaowen Wang
- Department of Otorhinolaryngology, The First Affiliated Hospital of Ningbo University, Ningbo, 315000, Zhejiang, China
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2
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Pham ST, Sakai O, Andreu-Arasa VC. Imaging approach to ingested foreign bodies in the neck. Neuroradiology 2024; 66:867-881. [PMID: 38619570 DOI: 10.1007/s00234-024-03348-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/25/2024] [Indexed: 04/16/2024]
Abstract
Foreign body ingestion is a common clinical occurrence worldwide, with high morbidity in the pediatric population and in adult patients with intentional attempts. Coins and button battery ingestions are more common among children. Bone impaction and swallowed dentures are usually seen in older adults. While most ingested foreign bodies pass through the gastrointestinal tract spontaneously with no complications, some require endoscopic and/or surgical intervention. Complications such as pharyngoesophageal ulceration, perforation, stricture, and deep neck infection can develop without timely diagnosis and management. The purpose of this article is to familiarize radiologists with the imaging approach to assess for characteristics and impacted locations of ingested foreign bodies in the neck.
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Affiliation(s)
- Serena T Pham
- Department of Radiology, Boston University Chobanian & Avedisian School of Medicine/Boston Medical Center, Boston, MA, USA
| | - Osamu Sakai
- Division of Neuroradiology, Department of Radiology, Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
| | - V Carlota Andreu-Arasa
- Department of Radiology, Boston University Chobanian & Avedisian School of Medicine/Boston Medical Center, Boston, MA, USA.
- Division of Neuroradiology, Department of Radiology, VA Boston Healthcare System, Boston, MA, USA.
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3
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Corman BHP, Bjorling A, Isildak H. Consideration of Hyoid Variability in the Diagnostic Workup of Fishbone Foreign Body Aspiration. J Craniofac Surg 2024; 35:e385-e386. [PMID: 38651891 DOI: 10.1097/scs.0000000000010130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 04/25/2024] Open
Abstract
Fishbone foreign body (FFB) can lodge in the upper respiratory or gastrointestinal tracts and frequently cause discomfort. While FFBs are common, variations in the hyoid may present radiographically similarly. The authors present a case in which a 32-year-old woman presented with pain in the right neck with a globus sensation after eating fish. Examination, including flexible fiberoptic laryngoscopy, did not reveal a foreign body. Given the patients' persistent symptoms, a noncontrast computed tomography was performed, demonstrating a radiopaque body superior to the right lateral hyoid bone, consistent with FFB. Direct examination under anesthesia was performed, and no FFB was noted. A reassessment of the imaging suggested a likely aberrant hyoid bone. The authors report this case to remind clinicians that while rare, aberrant hyoid variants may mimic FFB. The authors also review the imaging findings of aberrant hyoid variants in this report, as recognition of hyoid variability can mitigate unnecessary intervention.
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Affiliation(s)
| | - Alexander Bjorling
- Department of Otolaryngology-Head and Neck Surgery, Stony Brook University, Stony Brook, NY
| | - Huseyin Isildak
- Department of Otolaryngology-Head and Neck Surgery, Stony Brook University, Stony Brook, NY
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4
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Tuan HX, Hung ND, Quang NN, Tam NT, Anh NTH, Hoa T, Dung BT, Duc NM. Pulmonary artery penetration due to fish bone ingestion: A rare case report. Radiol Case Rep 2024; 19:1900-1906. [PMID: 38425774 PMCID: PMC10904187 DOI: 10.1016/j.radcr.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/01/2024] [Accepted: 02/03/2024] [Indexed: 03/02/2024] Open
Abstract
Accidental fish bone ingestion is a common manifestation at emergency departments. In most cases, ingested foreign bodies usually pass uneventfully through the gastrointestinal tract and complications only present in less than 5% of all patients. In this report, we present the first documented case of pulmonary artery injury due to a fish bone in a 63-year-old male patient hospitalized with hemoptysis after accidentally swallowing a fish bone 30 days ago. This patient subsequently had surgery and endoscopy to safely remove the foreign body and then recovered well on a follow-up examination. For cases of fish bone ingestion, contrast-enhanced chest computed tomography is one of the most essential tools to assess vascular problems and associated mediastinal infections-risk factors for life-threatening and long-term recurrent inflammation. Reconstructing planes along the foreign body axis and changing windows when analyzing CT scans is necessary to avoid missing lesions and dilemmas.
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Affiliation(s)
- Ho Xuan Tuan
- Department of Medical Imaging, Da Nang University of Medical Technology and Pharmacy, Danang, Vietnam
| | - Nguyen Duy Hung
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
- Department of Radiology, Viet Duc Hospital, Hanoi, Vietnam
| | | | - Nguyen-Thi Tam
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
| | | | - Tran Hoa
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Bui The Dung
- Department of Cardiology, University Medical Center HCMC, Ho Chi Minh City, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
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5
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Li D, Zeng WT, Jiang JG, Chen JC. Translocation of a fish spike from the pharynx to the thyroid gland: A case report. World J Clin Cases 2024; 12:1365-1370. [PMID: 38524516 PMCID: PMC10955535 DOI: 10.12998/wjcc.v12.i7.1365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/17/2024] [Accepted: 02/03/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND A fish spike stuck in the throat is a common ear, nose, and throat (ENT) emergency. However, it is very rare for a fish spike to reach the thyroid tissue through the throat, which is very dangerous and can lead to pharyngeal fistula, cervical abscess, mediastinal abscess, and thyroid abscess. Proper and timely management can help reduce complications, especially in elderly patients. CASE SUMMARY In the case presented here, the causative factor was dentures, but improper management aggravated the condition. In the case presented here, an elderly woman with a history of accidentally swallowing fish bones for 20 d had a sensation of foreign bodies in her throat. Eventually, computed tomography (CT) of the neck showed that the left side of the thyroid gland had a dense shadow in the form of a stripe. CONCLUSION If a fishbone foreign body is not visible during endoscopic examination but the patient has significant symptoms, the surgeon should be aware that the fishbone may be lodged in the thyroid. To avoid a misdiagnosis, ultrasound, CT, and other tests can be used to clarify the diagnosis. T The first step in treating a fish bone in the thyroid gland is to determine the position of the foreign body and the extent of the infection, and to develop a personalized surgical plan for its removal. At the same time, scientific information should be made available to the general public so that people know that if a fish bone is accidentally lodged, they should not force it to be swallowed or be spit out by inducing vomiting, which are incorrect methods and may aggravate the condition or even cause it to migrate outside the cavity, leading to serious complications, as in this reported case.
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Affiliation(s)
- Deng Li
- Department of Otolaryngology Head and Neck Surgery, Army Medical Center of PLA, Chongqing 400042, China
| | - Wan-Ting Zeng
- Department of Otolaryngology Head and Neck Surgery, Army Medical Center of PLA, Chongqing 400042, China
| | - Jian-Guo Jiang
- Department of Otolaryngology Head and Neck Surgery, Army Medical Center of PLA, Chongqing 400042, China
| | - Ji-Chuan Chen
- Department of Otolaryngology Head and Neck Surgery, Army Medical Center of PLA, Chongqing 400042, China
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Yuen AHL, Lee SB, Kim SW, Lee YM, Kim DG, Poon CTC, Seo JP, Baeck GW, Kim BY, Park SC. Fatal upper aerodigestive tract obstruction in an East Asian finless porpoise (Neophocaena asiaeorientalis sunameri): findings in post-mortem computed tomography. Forensic Sci Med Pathol 2023:10.1007/s12024-023-00732-0. [PMID: 37831312 DOI: 10.1007/s12024-023-00732-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 10/14/2023]
Abstract
The present case report aims to outline the post-mortem findings of an East Asian finless porpoise with upper aerodigestive tract obstruction using different post-mortem computed tomography (PMCT) visualization techniques and discusses the potential cause of death of this individual. A dead-stranded adult male East Asian finless porpoise was recovered from the Northern coast of Jeju Island, Republic of Korea. The carcass was frozen in Jeju National University within 2 h upon first reported. The PMCT examinations were performed at 120 kVp, 200 mAs with a section thickness of 1 mm. The scan field of view (sFOV) was set to 400 mm. Four image rendering techniques, including multi-planar reconstruction, three-dimensional volume rendering, perspective volume rendering, and minimum intensity projection technique, were used to aid the diagnosis of upper aerodigestive tract obstruction in the stranded finless porpoise. Conventional necropsy was performed to provide a complete necropsy report. Using PMCT, a Sebastidae of 24 cm measured length was found to be lodged in the left pharyngeal food channel and esophagus of the finless porpoise. Hard rays of the pectoral fin of the lodged fish have impaled the esophageal mucosa. Fishing gear was found to embed at the dorsal side of the lodged fish. The trachea was compressed ventrally and the arytenoepiglottic tube opening has been narrowed, which may precipitate to the finless porpoise difficult breathing. Pulmonary hyperinflation, pulmonary edema, pneumothorax, pneumopericardium, and pneumorrhachis were observed. This case report represents the first documentation of potential radiological indicators of upper aerodigestive tract obstruction in the East Asian finless porpoise using PMCT. Spatial location of the lodged item could be rendered in situ as the time of death. It has demonstrated that PMCT could provide objective measurements to adjunct the necropsy findings in diagnosis of fatal aerodigestive tract obstruction in stranded cetaceans.
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Affiliation(s)
- Adams Hei Long Yuen
- College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, South Korea
- Radiotherapy and Oncology Centre, Gleneagles Hospital Hong Kong, Wong Chuk Hang, Hong Kong SAR, China
| | - Sung Bin Lee
- College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, South Korea
| | - Sang Wha Kim
- Department of Microbiology and Immunology, Institute of Endemic Disease, College of Medicine, Seoul National University, Seoul, Republic of Korea
- College of Veterinary Medicine & Institute of Veterinary Science, Kangwon National University, Chuncheon, Gangwon, Republic of Korea
| | - Young Min Lee
- College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, South Korea
| | - Do-Gyun Kim
- Department of Marine Biology & Aquaculture/Department of Aquaculture Science/Institute of Marine Industry/Marine Bio-Education & Research Center, College of Marine Science, Gyeongsang National University, Tongyeong, Republic of Korea
| | | | - Jong-Pil Seo
- College of Veterinary Medicine and Veterinary Medical Research Institute, Jeju National University, Jeju, South Korea
| | - Gun Wook Baeck
- Department of Marine Biology & Aquaculture/Department of Aquaculture Science/Institute of Marine Industry/Marine Bio-Education & Research Center, College of Marine Science, Gyeongsang National University, Tongyeong, Republic of Korea
| | - Byung Yeop Kim
- Department of Marine Industrial and Maritime Police, College of Ocean Science, Jeju National University, Jeju, South Korea.
| | - Se Chang Park
- College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, South Korea.
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Xie H, Tu L, Li X, Du X, Zhou S. More attention should be paid to atrial-esophageal fistula, and not all atrial-esophageal fistulas are iatrogenic. ANNALS OF TRANSLATIONAL MEDICINE 2023; 11:372. [PMID: 37675317 PMCID: PMC10477651 DOI: 10.21037/atm-23-1275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/21/2023] [Indexed: 09/08/2023]
Affiliation(s)
- Hong Xie
- Department of Radiology, the Affiliated Hospital of Guizhou Medical University, Guiyang, China
- Graduate School, Soochow University, Suzhou, China
| | - Li Tu
- Department of General Practice, the Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Xuejun Li
- Department of Cardiovascular Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Xiaojun Du
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Shi Zhou
- Department of Interventional Radiology, the Affiliated Hospital of Guizhou Medical University, Guiyang, China
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8
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Wei HX, Lv SY, Xia B, Zhang K, Pan CK. Bedside ultrasound-guided water injection assists endoscopically treatment in esophageal perforation caused by foreign bodies: A case report. World J Gastrointest Surg 2023; 15:1240-1246. [PMID: 37405102 PMCID: PMC10315116 DOI: 10.4240/wjgs.v15.i6.1240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/21/2023] [Accepted: 04/17/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Fishbone migration from the esophagus to the neck is relatively uncommon in clinical practice. Several complications secondary to esophageal perforation after ingestion of a fishbone have been described in the literature. Typically, a fishbone is detected and diagnosed by imaging examination and is usually removed by a neck incision.
CASE SUMMARY Herein, we report a case of a 76-year-old patient with a fishbone in the neck that had migrated from the esophagus and that was in close proximity to the common carotid artery, and the patient experienced dysphagia. An endoscopically-guided neck incision was made over the insertion point in the esophagus, but the surgery failed due to having a blurred image at the insertion site during the operation. After injection of normal saline laterally to the fishbone in the neck under ultrasound guidance, the purulent fluid outflowed to the piriform recess along the sinus tract. With endoscopic guidance, the position of the fish bone was precisely located along the direction of liquid outflow, the sinus tract was separated, and the fish bone was removed. To the best of our knowledge, this is the first case report describing bedside ultrasound-guided water injection positioning combined with endoscopy in the treatment of a cervical esophageal perforation with an abscess.
CONCLUSION In conclusion, the fishbone could be located by the water injection method under the guidance of ultrasound and could be accurately located along the outflow direction of the purulent fluid of the sinus by the endoscope and was removed by incising the sinus. This method can be a nonoperative treatment option for foreign body-induced esophageal perforation.
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Affiliation(s)
- Hua-Xing Wei
- Department of Ultrasound, The Fourth Affiliated Hospital of Zhejiang University College of Medicine, Yiwu 322200, Zhejiang Province, China
| | - Song-Yong Lv
- Department of Ultrasound, Jinyun County People’s Hospital, Lishui 321400, Zhejiang Province, China
| | - Bin Xia
- Department of Ultrasound, The Fourth Affiliated Hospital of Zhejiang University College of Medicine, Yiwu 322200, Zhejiang Province, China
| | - Kai Zhang
- Department of Ultrasound, The Fourth Affiliated Hospital of Zhejiang University College of Medicine, Yiwu 322200, Zhejiang Province, China
| | - Chen-Ke Pan
- Department of Ultrasound, The Fourth Affiliated Hospital of Zhejiang University College of Medicine, Yiwu 322200, Zhejiang Province, China
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9
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Liu PF, Wu YY. Acute appendicitis caused by the fishbone. Asian J Surg 2023; 46:1446-1447. [PMID: 36150958 DOI: 10.1016/j.asjsur.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/07/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Peng-Fei Liu
- Department of Gastrointestinal Surgery, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, SuZhou, China
| | - Yun-Yun Wu
- Department of General Surgery, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, SuZhou, China.
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10
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Duncan SG, Fernandez-Criado RM, Narayanan A, Mary P. C, Moss WJ. Characterization of Otolaryngology Referrals among Pacific Islanders in the Commonwealth of the Northern Mariana Islands. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2022; 81:253-258. [PMID: 36118152 PMCID: PMC9460761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The burden of otolaryngology disease in Pacific Islander populations is relatively uncharacterized. A single-institution retrospective review was undertaken at the Commonwealth Healthcare Corporation in Saipan, the only hospital in the Commonwealth of the Northern Mariana Islands. Demographic, diagnostic, and treatment data were compiled from the clinical charts of all patients seen by an otolaryngologist between January 2015 and April 2020. For all Pacific Islanders in the sample (N=674), the average age was 40.2 (SD 22.4) years and ages ranged from 10 months to 89 years. Patients were 50.7% male and 49.3% female. The most common diagnoses affected the ear (40.8%), followed by the oral cavity/pharynx (23.2%), and nose (14.0%). Middle ear disease comprised 41.7% of reported ear disorders; the most common problem was otitis media (19.4%, n=68) followed by tympanic membrane perforation (14.0%, n=49). Head and neck cancers comprised 8.6% of all diagnoses. Most (77.8%) malignant neoplasms were oral cavity carcinomas. The average age at diagnosis for oral cancer was 46.6 years with a 1.8:1 male-to-female predominance. Patients with cancer of the oral cavity (n=56) chewed betel nut at higher rates (94.6%) compared with other adults in the sample (P<.001). Adult patients reported alcohol use, smoking, and chewing betel quid at rates of 26.5%, 39.9%, and 52.2% respectively. Otolaryngology referrals among Pacific Islanders in this sample were dominated by ear disease and included betel nut-related oral cavity disease.
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Affiliation(s)
- Steven G. Duncan
- University of Texas Southwestern Medical School, Dallas, TX (SGD, RMF, AN, MPC)
| | | | - Ajay Narayanan
- University of Texas Southwestern Medical School, Dallas, TX (SGD, RMF, AN, MPC)
| | - Chang Mary P.
- University of Texas Southwestern Medical School, Dallas, TX (SGD, RMF, AN, MPC)
| | - William J. Moss
- Commonwealth Health Center, Saipan, Northern Mariana Islands (WJM)
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11
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Wang CD, Liu YK, Hsu SC, Hsu YP. Comments on: "Comparison of lateral neck X-ray to neck CT in patients with suspicious bone impaction: Old habits die hard". Am J Otolaryngol 2022; 43:103372. [PMID: 35027241 DOI: 10.1016/j.amjoto.2021.103372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 12/10/2021] [Indexed: 11/01/2022]
Affiliation(s)
- Chia-Dim Wang
- Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ying-Kuo Liu
- Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shih-Chang Hsu
- Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yuan-Pin Hsu
- Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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12
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Feinmesser G, Eyal A, Shrot S, Belenky EA, Mansour J, Livneh N, HadasKnoler, Schindel H, Alon EE. Comparison of Lateral neck X-ray to Neck CT in patients with suspicious bone impaction: "Old habits die hard". Am J Otolaryngol 2022; 43:103373. [PMID: 35027242 DOI: 10.1016/j.amjoto.2021.103373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 12/30/2021] [Indexed: 11/01/2022]
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13
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Giordano D, Botti C, Iotti V, Ghidini A. Foreign Body in the Cervical Oesophagus: A Case Report. Curr Med Imaging 2022; 18:1117-1119. [PMID: 35379156 DOI: 10.2174/1573405618666220404110751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/27/2022] [Accepted: 02/14/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Foreign bodies in the upper aerodigestive tract represent an uncommon cause of visits to emergency departments. In the majority of cases, foreign bodies do not go beyond the pharynx. They cause dyspnoea or pneumonia if they reach the tracheo-bronchial tree. If ingested, they will pass spontaneously through the gastrointestinal canal in the majority of cases. Nevertheless, especially in case of sharp-pointed or large objects, the foreign bodies can stop in the oesophagus. In case of dysphagia, stinging sensation and/or odynophagia occurring after eating a meal, a foreign body in the upper aerodigestive tract should be suspected. If not clinically visible, imaging is required. CASE PRESENTATION A 72-year-old woman presented to the Emergency Department with pharyngodynia, odynophagia, stinging, dysphagia, and sialorrhea for 12 hours. Her symptoms started after eating a meal with meat. The patient underwent a standard two-projection radiogram of the neck. The antero-posterior projection radiogram was unremarkable. The lateral projection radiogram showed 16 millimetres in maximum length radiopaque foreign body within the cervical oesophagus. The patient underwent transoral flexible oesophagoscopy under general anaesthesia, with successful removal of the foreign body (bony fragment). Her symptoms improved rapidly after the procedure, and the patient was discharged after 48 hours in good health. CONCLUSION A foreign body in the cervical oesophagus may lead to visceral perforation. Once suspected, every effort should be made to identify and remove the foreign body to avoid potentially catastrophic consequences. In some cases, imaging could be necessary to detect the foreign body.
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Affiliation(s)
- Davide Giordano
- Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cecilia Botti
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Valentina Iotti
- Radiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Angelo Ghidini
- Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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14
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Huang HY, Wang CC. Migration of a Fish Bone From the Esophagus to the Thyroid Gland. EAR, NOSE & THROAT JOURNAL 2022:1455613221086032. [PMID: 35348022 DOI: 10.1177/01455613221086032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Accidental swallowing of fish bone is one of the most common emergencies in the otolaryngology department. The impacted fish bones are usually found in the palatine tonsil, base of the tongue, valleculae, pyriform sinus, and esophagus, which can be successfully removed after a thorough examination. However, in some cases, the fish bone may penetrate into the neck soft tissue and migrate to extraluminal organs, causing infection, abscess formation, or rupture of vessels. In such cases, prompt recognition and immediate removal of the impacted fish bone are necessary. Herein, we report a rare case of a 60-year-old woman who had accidently swallowed a fish bone 10 days prior to visiting the outpatient department. The fiberoptic scope and head and neck computed tomography scans were obtained from the outpatient department. The fish bone was found to migrate from the upper esophagus to the left thyroid gland. First, a rigid esophageal endoscopy was performed in the operating room, but no obvious fish bone was noted over the esophagus. Finally, the fish bone was removed via exploratory cervicotomy with left-sided total lobectomy of the thyroid. The patient recovered after the operation, and there were no further complications during the 3 years of follow-up.
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Affiliation(s)
- Hsiao-Yu Huang
- Department of Otolaryngology, Head and Neck Surgery, 63344E-Da Hospital, Kaohsiung, Taiwan
| | - Chien-Chung Wang
- Department of Otolaryngology, Head and Neck Surgery, 63344E-Da Hospital, Kaohsiung, Taiwan
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Seghers VJ, Kan JH, Somcio R, Sher AC, Paul Guillerman R, Sammer MBK. CT imaging of esophageal foreign bodies in children: a pictorial essay. Jpn J Radiol 2022; 40:262-270. [PMID: 34661860 DOI: 10.1007/s11604-021-01201-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/21/2021] [Indexed: 11/26/2022]
Abstract
Foreign body (FB) ingestion is common in children, particularly from 6 months to 3 years of age. As young children may be unable to provide a clinical history and the ingestion is often unwitnessed, imaging plays an important role in diagnosis, predicting outcomes and detecting complications that require surgical intervention. Since 2015, our institution's diagnostic algorithm for suspected airway foreign bodies has included a noncontrast airway FB CT (FB-CT) with the z-axis coverage spanning from the larynx to the proximal segmental bronchi of the lower lung zones. The effective dose of radiation from this FB-CT airway protocol is typically less than 1 mSv, compared to an effective dose of just under 1 mSv to up to 3 mSv for a fluoroscopic esophagram in children under 10 years of age and 1-3 mSv for a routine pediatric CT chest. In using the FB-CT airway protocol at our institution, we observed that esophageal rather than airway FBs were sometimes encountered on these exams. However, the confidence among radiologists for definitively diagnosing an esophageal foreign body on noncontrast CT was variable. Consequently, we created a teaching module of positive cases for our group of 21 pediatric body radiologists to increase their diagnostic confidence. This pictorial essay illustrates our institutional experience and can help others to confidently diagnose esophageal foreign bodies using a dedicated CT foreign body imaging protocol. At a similar radiation dose to a fluoroscopic esophagram, CT provides the additional advantage of an expedited diagnosis without the need for a radiologist on site.
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Affiliation(s)
- Victor J Seghers
- Singleton Department of Pediatric Radiology, Texas Children's Hospital, 6701 Fannin Street, Houston, TX, 77030, USA.
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA.
| | - J Herman Kan
- Singleton Department of Pediatric Radiology, Texas Children's Hospital, 6701 Fannin Street, Houston, TX, 77030, USA
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Ray Somcio
- Singleton Department of Pediatric Radiology, Texas Children's Hospital, 6701 Fannin Street, Houston, TX, 77030, USA
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Andrew C Sher
- Singleton Department of Pediatric Radiology, Texas Children's Hospital, 6701 Fannin Street, Houston, TX, 77030, USA
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - R Paul Guillerman
- Singleton Department of Pediatric Radiology, Texas Children's Hospital, 6701 Fannin Street, Houston, TX, 77030, USA
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Marla B K Sammer
- Singleton Department of Pediatric Radiology, Texas Children's Hospital, 6701 Fannin Street, Houston, TX, 77030, USA
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
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16
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Feinmesser G, Eyal A, Shrot S, Belenky EA, Mansour J, Livneh N, Knoller H, Schindel H, Alon EE. Comparison of lateral neck X-ray to neck CT in patients with suspicious bone impaction: "Old habits die hard". Am J Otolaryngol 2022; 43:103237. [PMID: 34560599 DOI: 10.1016/j.amjoto.2021.103237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 09/11/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Bone impaction (BI) is a common cause for emergency room visits. Among foreign bodies, fish bone is considered the most common. The sensitivity of symptoms in predicting BI is relatively low, making imaging a central tool to aid diagnosis. Current imaging practices include both neck plain film radiography and none-contrast CT scans of the neck. We evaluated the accuracy of neck plain film radiography and CT scans of the neck for the diagnosis of BI. METHODS Retrospective review of all patients who presented to the emergency room between 2009 and 2016 with a suspicious history of BI whom underwent plain film neck radiography or CT. All Images were reviewed by two neuro-radiologist blinded to the clinical symptoms and findings. Symptoms, clinical findings and images results were compared to the final diagnosis. RESULTS 89 patients (30.7%), out of 290 patients who presented with complaints of BI, were diagnosed with BI. Mean age was 44.7 years old. Plain film neck radiography failed to predict BI (sen. 14.4%, spe 89.8% accuracy 63.2%), neck CT has an improved accuracy and sensitivity in locating BI (sen. 83.3%, spe. 94.1% accuracy 92.5%). Interobserver agreement between the two neuro-radiologists was moderate (0.46) and substantial (0.77) in neck radiography and CT images, respectively. Neck radiography missed 60 (out of 61) oropharyngeal BI's. CONCLUSION Neck radiography has high inter-observer variability and low sensitivity for the diagnosis of BI. Neck CT should be the first imaging modality in patients with suspicious complaints for BI and negative physical exam.
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Affiliation(s)
- Gilad Feinmesser
- Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Tel Hashomer 526200, Israel.
| | - Ana Eyal
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer 526200, Israel.
| | - Shai Shrot
- Sackler Faculty of Medicine, Tel Aviv University, 6997802, Israel; Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer 526200, Israel
| | - Eugenia A Belenky
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer 526200, Israel.
| | - Jobran Mansour
- Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Tel Hashomer 526200, Israel; Sackler Faculty of Medicine, Tel Aviv University, 6997802, Israel
| | - Nir Livneh
- Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Tel Hashomer 526200, Israel
| | - Hadas Knoller
- Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Tel Hashomer 526200, Israel
| | - Hilla Schindel
- Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Tel Hashomer 526200, Israel
| | - Eran E Alon
- Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Tel Hashomer 526200, Israel; Sackler Faculty of Medicine, Tel Aviv University, 6997802, Israel.
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Olley BM, Zhu Y, Ozbek L, Ringrose T, Lau C. Submucosal Intraglossal Fish Bone Extraction: A Case for the Multidisciplinary Team. Cureus 2021; 13:e20263. [PMID: 35004066 PMCID: PMC8735846 DOI: 10.7759/cureus.20263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 11/13/2022] Open
Abstract
Most impacted fish bones in the aerodigestive tract are easily removed or managed in the emergency department. Occasionally, they present as a diagnostic and surgical challenge. We present a case of a submucosal intraglossal fish bone extraction in a 38-year-old male who presented with localized pain in his tongue. This case highlights several key factors contributing to the successful outcome, including multidisciplinary input from anaesthesiology, radiology, and the oral and maxillofacial surgical team. The use of a pre-operative computed tomography (CT) scan, nasal intubation, and intra-operative ultrasound scan potentially minimised the risk of associated complications.
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18
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赵 延, 张 媛, 李 瑶, 李 彦, 徐 文. [Application of esophageal CT to establish the evaluation model of foreign body position in rigid esophagoscopic surgery]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2021; 35:1097-1100. [PMID: 34886623 PMCID: PMC10127656 DOI: 10.13201/j.issn.2096-7993.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Indexed: 06/13/2023]
Abstract
Objective:Establish a correlation model with the true position of the foreign body in the esophageal foreign body surgery using the relevant diameter of the esophageal foreign body computed tomography(CT). Methods:Thirty-three patients who were diagnosed with esophageal foreign bodies by esophageal CT in the emergency department of the Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, were selected to measure the CT-related diameters of the esophageal tube(airway length, hyoid anterior edge-mandibular distance, incisor extension line-Posterior nasal ridge, distance from foreign body to hard jaw, distance from foreign body to incisor, front and back nasal crest line-spine line included angle, front and back nasal crest line and airway length line included angle, the lowest point of mandible-highest point of hyoid bone-and Spine angle), record the height and weight of the patient and calculate the body mass index(BMI). During the operation, the patient's head is fully tilted back, and the rigid esophagus is inserted through the mouth, and the front end of the esophagus is recorded when it touches a foreign body. The method of multivariate linear analysis was used to calculate the CT diameter that correlated with the distance between the foreign body and the incisor during the operation. Results:The most common foreign body in the esophagus is jujube pit(14 cases), followed by fish bones(13 cases); the distance between the foreign body and the hard jaw, the incisor teeth measured by CT of the esophagus is less than the actual distance between the foreign body and the incisor during the operation(P<0.001), the difference was statistically significant. Multiple linear regression analysis found that the patient's BMI(P=0.037) and the distance of the foreign body from the hard jaw(P<0.001) were correlated with the actual distance of the foreign body from the incisor during the operation. LR=3.708+0.130×BMI+0.857×Lct(cm), R²=0.736, adjusted R²=0.719. Conclusion:The distance between the foreign body and the hard jaw measured by esophageal CT combined with the patient's BMI can predict the distance of the foreign body during rigid esophagoscopic surgery under general anesthesia and provide a certain reference value for the detection of foreign body during the operation.
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Affiliation(s)
- 延明 赵
- 首都医科大学附属北京同仁医院耳鼻咽喉头颈外科 北京市耳鼻咽喉科研究所 鼻病研究北京市重点实验室(北京,100730)Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, 100730, China
| | - 媛 张
- 首都医科大学附属北京同仁医院耳鼻咽喉头颈外科 北京市耳鼻咽喉科研究所 鼻病研究北京市重点实验室(北京,100730)Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, 100730, China
- 首都医科大学附属北京同仁医院过敏科Department of Allergy, Beijing Tongren Hospital, Capital Medical University
| | - 瑶 李
- 首都医科大学附属北京同仁医院耳鼻咽喉头颈外科 北京市耳鼻咽喉科研究所 鼻病研究北京市重点实验室(北京,100730)Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, 100730, China
| | - 彦如 李
- 首都医科大学附属北京同仁医院耳鼻咽喉头颈外科 北京市耳鼻咽喉科研究所 鼻病研究北京市重点实验室(北京,100730)Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, 100730, China
| | - 文 徐
- 首都医科大学附属北京同仁医院耳鼻咽喉头颈外科 北京市耳鼻咽喉科研究所 鼻病研究北京市重点实验室(北京,100730)Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, 100730, China
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19
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Chansangrat J. Diagnostic Performance of Digital Radiograph and Low-Dose Computed Tomography for the Diagnosis of Fishbone Retention in the Oropharynx. Int Arch Otorhinolaryngol 2021; 26:e401-e406. [PMID: 35846813 PMCID: PMC9282956 DOI: 10.1055/s-0041-1735567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 08/04/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction
Fishbone foreign body retention is one of the most common problem with various clinical manifestations from asymptomatic, abscess formation, and perforation to mediastinitis with subsequence morbidity and mortality. Accurately identifying the location of the fishbone leads to precise removal, which, in turn, prevents serious consequences. Digital radiographs have been widely used for diagnosis, but many studies show poor sensitivity.
Object
The present study was designed to compare the diagnostic performances of digital radiograph and low-dose computed tomography (CT) for fishbone retention and to demonstrate the radiation dose of the two modalities.
Methods
We collected 2 pieces of fishbone from each of the 15 species commonly eaten in Southeast Asia. We embedded each fishbone in a fresh pig's neck, then subjected the pig's neck to lateral soft tissue neck digital radiograph. The locations to embed included tonsil, base of tongue, and upper esophagus. Then, we subjected the same specimen to a CT scan. Two experienced radiologists interpreted each image.
Results
Visibility in the digital radiograph group was 13%, and in CT images group, it was 87% regardless of the locations. The average radiation dose from digital radiographs was 0.4 mGy (radiation dose field), while from CT images it was 8.6 mGy (CT dose index).
Conclusion
Most of the common fishbones in Southeast Asia could not be visualized by digital radiograph when embedded in the neck. Computed tomography scans demonstrated better diagnostic performance of fishbone retention compared to digital radiographs, regardless of the embedded location.
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Affiliation(s)
- Jirapa Chansangrat
- School of Radiology, Medical Institute, Suranaree University of Technology, Nakhon Ratchasima, Thailand
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20
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Shishido T, Suzuki J, Ikeda R, Kobayashi Y, Katori Y. Characteristics of fish-bone foreign bodies in the upper aero-digestive tract: The importance of identifying the species of fish. PLoS One 2021; 16:e0255947. [PMID: 34403441 PMCID: PMC8370622 DOI: 10.1371/journal.pone.0255947] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/27/2021] [Indexed: 02/07/2023] Open
Abstract
Background Fish bones are common foreign bodies in the upper aero-digestive tract, but their clinical features in relation to fish species have not been confirmed. We aimed to clarify the clinical characteristics of fish-bone foreign bodies and their location and removal methods depending on the fish species. Study design Retrospective, observational, monocentric study. Methods From October 2015 to May 2020, 368 patients visited the Department of Otolaryngology-Head and Neck Surgery at Tohoku University Hospital complaining of dysphagia, sore throat, or pharyngeal discomfort after eating fish. We analyzed the patients’ sex and age distribution, foreign-body location, type of the fish, and the techniques used for removing the foreign body. Results Fish bones were confirmed in the upper aero-digestive tract in 270 cases (73.4%), of which 236 (87.4%) involved fish-bone foreign bodies in the mesopharynx. The most frequently involved site was the palatine tonsil (n = 170). Eel was the most frequently observed fish species (n = 39), followed by mackerel (n = 33), salmon (n = 33), horse mackerel (n = 30), and flounder (n = 30). Among the 240 cases in which the bones did not spontaneously dislocate, 109 (45.4%) were treated by endoscopic removal (103 cases) or surgery (6 cases). In pediatric cases (<12 years old), almost all fish bones were found in the mesopharynx (138/139, 99.3%), and 31 cases (22.3%) required endoscopic removal. Flounder fish bones were often lodged in the hypopharynx and esophagus (9/30, 30%), hindering spontaneous dislocation and frequently necessitating endoscopic or surgical removal (19/29, 65.5%). Conclusion The characteristics of fish-bone foreign bodies differed depending on the fish species. Flounder bones were often stuck in the hypopharynx and esophagus and were likely to require more invasive removal methods. Confirming the species of the fish could facilitate appropriate diagnosis and treatment of fish-bone foreign bodies.
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Affiliation(s)
- Tadahisa Shishido
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Jun Suzuki
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Ryoukichi Ikeda
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yuta Kobayashi
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yukio Katori
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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21
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Abstract
Fishbone ingestion is quite common. Most of the time, patients are asymptomatic and the fish bone exits the gastrointestinal tract spontaneously. However, in some rare cases, it can drop in the appendix and induce appendicitis or even appendicitis with perforation. Herein, we report the unusual case of an 18-year-old woman, who presented with acute right lower abdominal pain. Computed tomography suggested the presence of acute appendicitis with a linear foreign body of 3 cm in length. The patient underwent an open appendectomy and removal of the fish bone without stigmata of perforation. The postoperative course was uneventful.
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Affiliation(s)
- Marouane Harhar
- Surgical Oncology, Mohammed VI University Hospital, Regional Oncology Center, Oujda, MAR
| | - Rachid Jabi
- Visceral Surgery, Mohamed VI University Hospital, Oujda, MAR
| | - Tijani El Harroudi
- Surgical Oncology, Mohammed VI University Hospital, Regional Oncology Center, Oujda, MAR
| | - Mohammed Bouziane
- General Surgery , Surgical Oncology, Mohammed VI University Hospital Centre, Oujda, MAR
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22
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Muhammad A, Tuang GJ, Zahedi FD, Nik Hussin NR. Migratory Fish Bone Presented With Extensive Surgical Subcutaneous Emphysema: A Case Report. J Emerg Med 2021; 61:e4-e6. [PMID: 33863569 DOI: 10.1016/j.jemermed.2021.02.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/07/2021] [Accepted: 02/06/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Fishbone ingestion represents a common cause for emergency department (ED) referral. In the majority of cases, an observed fishbone can be easily retrieved in the clinic setting. An impacted fishbone in the throat, albeit uncommon, carries potential risks of life-threatening events. Unusual complications caused by a migrated fishbone, including deep neck abscess, airway obstruction, and major vessels injury, are greatly influenced by the type of ingested fishbone and time between onset and presentation. CASE REPORT Here we report an unusual case of surgical subcutaneous emphysema after multiple attempts of purging to remove an ingested fishbone. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Fishbone foreign body is a common presentation to the ED. A thorough history and examination for the migratory foreign body is essential, as the complications are consequential.
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Affiliation(s)
- Athierah Muhammad
- Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Selayang, Batu Caves, Selangor, Malaysia
| | - Geng Ju Tuang
- Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Selayang, Batu Caves, Selangor, Malaysia; Department of Otorhinolaryngology, Head and Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | - Farah Dayana Zahedi
- Department of Otorhinolaryngology, Head and Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | - Nik Roslina Nik Hussin
- Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Selayang, Batu Caves, Selangor, Malaysia
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23
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Sammer MBK, Kan JH, Somcio R, Sher AC, Hansen CM, Pahlka RB, Guillerman RP, Seghers VJ. Chest CT for the Diagnosis of Pediatric Esophageal Foreign Bodies. Curr Probl Diagn Radiol 2021; 50:566-570. [PMID: 33745769 DOI: 10.1067/j.cpradiol.2021.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/04/2021] [Indexed: 01/08/2023]
Abstract
Foreign body ingestion is a common problem in children. Radiography is the mainstay of imaging, but many radiolucent items go undetected without further imaging by fluoroscopic esophagram. While studies in adults support the use of computed tomography (CT) for esophageal foreign body ingestion, CT has historically not been used in children given the typically higher radiation doses on CT compared with fluoroscopy. In distinction to an esophagram, CT does not require oral contrast nor presence of an onsite radiologist and can be interpreted remotely. At our institution, a dedicated CT protocol has been used for airway foreign bodies since 2015. Given the advantages of CT over esophagram, we retrospectively reviewed institutional radiation dose data from 2017 to 2020 for esophagrams, airway foreign body CT (FB-CT), and routine CT Chest to compare effective doses for each modality. For ages 1+ years, effective dose was lowest using the FB-CT protocol; esophagram mean dose showed the most variability, and was over double the dose of FB-CT for ages 5+ years. Routine CT chest doses were uniformly highest across all age ranges. Given these findings, we instituted a CT foreign body imaging protocol as the first-line imaging modality for radiolucent esophageal foreign body at our institution.
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Affiliation(s)
- Marla B K Sammer
- Singleton Department of Pediatric Radiology, Texas Children's Hospital, Houston TX.; Department of Radiology, Baylor College of Medicine, Houston TX
| | - J Herman Kan
- Singleton Department of Pediatric Radiology, Texas Children's Hospital, Houston TX.; Department of Radiology, Baylor College of Medicine, Houston TX
| | - Ray Somcio
- Singleton Department of Pediatric Radiology, Texas Children's Hospital, Houston TX.; Department of Radiology, Baylor College of Medicine, Houston TX
| | - Andrew C Sher
- Singleton Department of Pediatric Radiology, Texas Children's Hospital, Houston TX.; Department of Radiology, Baylor College of Medicine, Houston TX
| | - Carly M Hansen
- Singleton Department of Pediatric Radiology, Texas Children's Hospital, Houston TX
| | - R Benton Pahlka
- Singleton Department of Pediatric Radiology, Texas Children's Hospital, Houston TX
| | - R Paul Guillerman
- Singleton Department of Pediatric Radiology, Texas Children's Hospital, Houston TX.; Department of Radiology, Baylor College of Medicine, Houston TX
| | - Victor J Seghers
- Singleton Department of Pediatric Radiology, Texas Children's Hospital, Houston TX.; Department of Radiology, Baylor College of Medicine, Houston TX..
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Mathew RP, Sarasamma S, Jose M, Toms A, Jayaram V, Patel V, Low G. Clinical presentation, diagnosis and management of aerodigestive tract foreign bodies in the adult population: Part 1. SA J Radiol 2021; 25:2022. [PMID: 33936794 PMCID: PMC8063768 DOI: 10.4102/sajr.v25i1.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/14/2020] [Indexed: 12/11/2022] Open
Abstract
In the adult population, foreign bodies may be accidentally or intentionally ingested or even inserted into a body cavity. The majority of accidentally ingested foreign bodies pass through the alimentary tract without any complications and rarely require intervention. Accidentally ingested foreign bodies are usually fish bones, bones of other animals, and dentures. Oesophageal food impaction is the commonest cause of oesophageal foreign bodies in the Western hemisphere. Intentionally ingested foreign bodies may be organic or inorganic, and often require intervention; these patients have either underlying psychological or mental disease or are involved in illegal activities such as body packing, which involves trafficking narcotics. Imaging plays a crucial role in not only identifying the type, number and location of the foreign body but also in excluding any complications. In this comprehensive pictorial review, we provide an overview of the spectrum of foreign bodies ingested in adults, emphasising the role of various imaging modalities, their limitations and common foreign body mimickers on imaging.
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Affiliation(s)
- Rishi P Mathew
- Department of Radiology, Faculty of Radiology, Rajagiri Hospital, Aluva, India
| | - Sreekutty Sarasamma
- Department of Radiology, Faculty of Radiology, Rajagiri Hospital, Aluva, India
| | - Merin Jose
- Department of Radiology, Faculty of Radiology, Rajagiri Hospital, Aluva, India
| | - Ajith Toms
- Department of Radiology, Faculty of Radiology, Rajagiri Hospital, Aluva, India
| | - Vinayak Jayaram
- Department of Radiology, Faculty of Radiology, Rajagiri Hospital, Aluva, India
| | - Vimal Patel
- Department of Radiology & Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, Canada
| | - Gavin Low
- Department of Radiology & Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, Canada
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25
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Wu TC, Huang PW, Tung CB. Does plain radiography still have a role in cases of fish bone ingestion in emergency rooms? A retrospective analysis. Emerg Radiol 2021; 28:627-631. [PMID: 33506364 PMCID: PMC8121746 DOI: 10.1007/s10140-020-01891-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 12/16/2020] [Indexed: 11/18/2022]
Abstract
Background Fish bones are the most common aerodigestive foreign bodies found in adults. Most cases of fish bone impaction improve after primary management by emergency physicians with a mirror laryngoscopy using a tongue depressor, before otolaryngologists perform a fiberoptic nasendoscopy. A computed tomography scan usually follows to determine the next step. Studies have recently been concerned about overdoses of radiation from computed tomography. However, clear algorithms remain unavailable for fish bone ingestion management to date. Methods A retrospective review was conducted on 180 patients who visited the emergency department with complaints of fish bone impaction between January 2017 and January 2019. Results A total of 81.6% of patients with fish bone impaction got symptomatic relief after primary management by emergency physicians and otolaryngologists. Out of 180 patients, 33 (18.3%) needed an endoscopic procedure due to persistent symptoms. Only one (0.56%) required an operation due to perforation. In the group failing primary management, the plain radiography of eight patients showed a positive finding and an esophagogastroscopy was done to remove the fish bones. Conclusion Lateral neck radiography is still beneficial to patients with fish bone ingestion failure from primary management. Positive lateral soft tissue radiography in cases with persistent symptoms post primary management may directly suggest esophagogastroscopy without confirmation from a computed tomography, unless complications are suspected. For patients aged below 40, following up on their conditions after post management radiography shows negative results may increase their safety.
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Affiliation(s)
- Tzu-Chi Wu
- Department of Emergency Medicine, Show Chwan Memorial Hospital, Changhua, Taiwan. .,Graduate Institute of Technology Management, National Chung Hsing University, Taichung, Taiwan.
| | - Pin-Wen Huang
- Department of Emergency Medicine, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Chun-Bin Tung
- Department of Emergency Medicine, Show Chwan Memorial Hospital, Changhua, Taiwan
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26
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Mathew RP, Jayaram V, Toms A, Joshi M. Fish bone induced bronchial artery pseudoaneurysm in a patient with underlying bronchiectasis—a case report. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00253-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Abstract
Background
Fish bones are the most common cause of accidental foreign body ingestion, especially in Asian and Mediterranean nations. In most cases, the fish bones pass through the alimentary tract without any complications and rarely require any intervention. Less than 5% of the patients with accidentally ingested fish bones develop complications. In this report, we present the first documented case of a fish bone induced bronchial artery pseudoaneurysm in an elderly male with underlying bronchiectasis; the latter recognized as a risk factor for developing bronchial artery hypertrophy.
Case presentation
We report a case of a fish bone induced bronchial artery pseudoaneurysm in a patient with underlying bronchiectasis. The vascular complication induced by the fish bone was identified only on intravenous contrast CT and would not have been identified on plain CT alone. The patient underwent bronchial artery embolization, following which the fish bone was dis-impacted endoscopically.
Conclusions
Intravenous post contrast chest CT may have an important role in the evaluation of accidental fish bone ingestion, especially in patients with underlying lung diseases, as vascular complications are most often overt on a non-contrast CT study.
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Jotz GP, Bittencourt AG, Montefusco AM. IAO Systematic Review Award 2020. Int Arch Otorhinolaryngol 2020; 24:e397-e398. [PMID: 33101501 PMCID: PMC7575380 DOI: 10.1055/s-0040-1718748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Geraldo Pereira Jotz
- Department of Morphological Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Yi L, Cheng Z, Zhou Y, Wang Q, Liu Y, Liu K, Wang T, Zhong X. Fishbone foreign body ingestion in duodenal papilla: a cause of abdominal pain resembling gastric ulcer. BMC Gastroenterol 2020; 20:323. [PMID: 33008291 PMCID: PMC7532595 DOI: 10.1186/s12876-020-01475-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 09/28/2020] [Indexed: 12/30/2022] Open
Abstract
Background Foreign body ingestion is a common clinical problem. The upper esophagus is the most common site of foreign body, accounting for more than 75% of all cases, but cases with a foreign body in the duodenal papilla or common bile duct are rarely reported. Case presentation Herein, we report a rare case that a patient’s abdominal pain resembling gastric ulcer was caused by a 3 cm long fishbone inserted into the duodenal papilla. Conclusion Fishbone inserted into the duodenal papilla can cause an abdominal pain resembling gastric ulcer. Endoscopy is useful for the diagnosis and treatment of fishbone ingestion in clinical.
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Affiliation(s)
- Lizhi Yi
- Department of Gastroenterology, People's Hospital of Leshan, Leshan, Sichuan, People's Republic of China.
| | - Zhengyu Cheng
- Department of Gastroenterology, People's Hospital of Leshan, Leshan, Sichuan, People's Republic of China
| | - Yafei Zhou
- Department of Anesthesiology, People's Hospital of Leshan, Leshan, Sichuan, People's Republic of China
| | - Qin Wang
- Department of Gastroenterology, People's Hospital of Leshan, Leshan, Sichuan, People's Republic of China
| | - Yangyang Liu
- Department of Gastroenterology, People's Hospital of Leshan, Leshan, Sichuan, People's Republic of China
| | - Ke Liu
- Department of Gastroenterology, People's Hospital of Leshan, Leshan, Sichuan, People's Republic of China
| | - Tao Wang
- Department of Radiology, People's Hospital of Leshan, Leshan, Sichuan, People's Republic of China
| | - Xianfei Zhong
- Department of Gastroenterology, People's Hospital of Leshan, Leshan, Sichuan, People's Republic of China
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Ho NH, Chang FC, Wang YF. Clinical Approaches to Migrating Ingested Foreign Bodies in the Neck. EAR, NOSE & THROAT JOURNAL 2020; 101:181-185. [PMID: 32791905 DOI: 10.1177/0145561320948787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
This report presents 2 unusual cases along with a review of the current literature. Further, it aims to propose an algorithm for the initial surgical management of migrating ingested foreign bodies, focusing on the use of fluoroscopy, rigid laryngopharyngoscopy, and an external surgical approach. A 42-year-old man presented with progressive odynophagia after swallowing a fish bone 20 days previously, and a 60-year-old woman presented with a painful enlarging mass over the left lower neck for 1 month. The first case involved a horizontally oriented pharyngeal fish bone with a portion in the neck, which was removed under fluoroscopic guidance and rigid laryngopharyngoscopy in succession. In the second case, there was an extraluminal fish bone that had migrated into the sternocleidomastoid muscle, which was retrieved through cervical incision. All foreign bodies were removed without complications. To the best of our knowledge, this is the second report of fluoroscopy-guided ingested foreign body retrieval and the first one with a proposed algorithm for the management of migrating ingested foreign body in the neck. The location and orientation of migrating ingested foreign bodies as well as their relation to structures in the neck are important factors in determining the surgical approach.
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Affiliation(s)
- Nien-Hsuan Ho
- Department of Otorhinolaryngology-Head and Neck Surgery, 46615Taipei Veterans General Hospital and National Yang-Ming University, Taipei
| | - Feng-Chi Chang
- Department of Radiology, 46615Taipei Veterans General Hospital, Taipei.,Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei
| | - Yi-Fen Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, 46615Taipei Veterans General Hospital and National Yang-Ming University, Taipei
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Kuwahara K, Mokuno Y, Matsubara H, Kaneko H, Shamoto M, Iyomasa S. Development of an abdominal wall abscess caused by fish bone ingestion: a case report. J Med Case Rep 2019; 13:369. [PMID: 31837708 PMCID: PMC6911699 DOI: 10.1186/s13256-019-2301-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 10/18/2019] [Indexed: 12/15/2022] Open
Abstract
Background A small percentage of patients with foreign body ingestion develop complications, which have a variety of clinical presentations. Less than 1% of cases require surgical intervention. We present a patient with an abdominal wall abscess resulting from a fish bone that pierced the cecum. The patient was treated laparoscopically. Case presentation A 55-year-old Japanese man presented to our hospital with a complaint of right lower abdominal pain. A physical examination revealed tenderness, swelling, and redness at the right iliac fossa. Computed tomography showed a low-density area with rim enhancement in his right internal oblique muscle and a hyperdense 20 mm-long pointed object in the wall of the adjacent cecum. Based on the findings we suspected an abdominal wall abscess resulting from a migrating ingested fish bone. He was administered antibiotics as conservative treatment, and the abscess was not seen on subsequent computed tomography. Two months after the initial treatment, he presented with the same symptoms, and a computed tomography scan showed the foreign body in the same location as before with the same low-density area. We diagnosed the low-density area as recurrence of the abdominal wall abscess. He underwent laparoscopic surgery to remove the foreign body. His appendix, and part of his cecum and the parietal peritoneum that included the foreign body, were resected. He had an uneventful postoperative course, and at 1 year after the surgery, the abdominal wall abscess had not recurred. Conclusions An abdominal wall abscess developed in association with the migration of an ingested fish bone. We suggest that a laparoscopic surgical resection of the portion of the bowel that includes the foreign body is a useful option for selected cases.
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Affiliation(s)
- Kiyomitsu Kuwahara
- Department of Surgery, Yachiyo Hospital, 2-2-7, Sumiyoshi-cho, Anjo-shi, Aichi, 446-8510, Japan.
| | - Yasuji Mokuno
- Department of Surgery, Yachiyo Hospital, 2-2-7, Sumiyoshi-cho, Anjo-shi, Aichi, 446-8510, Japan
| | - Hideo Matsubara
- Department of Surgery, Yachiyo Hospital, 2-2-7, Sumiyoshi-cho, Anjo-shi, Aichi, 446-8510, Japan
| | - Hirokazu Kaneko
- Department of Surgery, Yachiyo Hospital, 2-2-7, Sumiyoshi-cho, Anjo-shi, Aichi, 446-8510, Japan
| | - Mikihiro Shamoto
- Department of Pathology, Yachiyo Hospital, 2-2-7, Sumiyoshi-cho, Anjo-shi, Aichi, 446-8510, Japan
| | - Shinsuke Iyomasa
- Department of Surgery, Yachiyo Hospital, 2-2-7, Sumiyoshi-cho, Anjo-shi, Aichi, 446-8510, Japan
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