Foreign body embedded in the lower esophageal wall located by endoscopic ultrasonography: A case report

Bedside ultrasound-guided water injection assists endoscopically treatment in esophageal perforation caused by foreign bodies: A case report

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.

Submucosal protuberance caused by a fish bone in the absence of preoperative positive signs: A case report

BACKGROUND

Submucosal protuberance caused by fish bone insertion into the digestive tract has rarely been reported. These cases usually include patients with clear signs such as a history of fish intake, pain, and dysphagia, as well as positive findings on endoscopy and imaging. Here, we report a case of a fish bone hidden in the submucosal protuberance of the gastric antrum during endoscopic submucosal dissection without preoperative obvious positive signs.

CASE SUMMARY

A 58-year-old woman presented with epigastric pain for the past 20 d and a submucosal protuberance. Abdominal computed tomography and endoscopic ultrasonography did not indicate the presence of a fish bone. We assumed the cause to be an ordinary submucosal eminence and performed an endoscopic submucosal dissection to confirm its essence. During the operation, a fish bone approximately 20 mm in length was found incidentally.

CONCLUSION

Our report could potentially prevent the oversight of embedded fish bones and associated adverse effects in patients with similar presentation.

Extraction of Fish Bones Embedded in the Esophagus via Endoscopic Submucosal Dissection: Two Case Reports and Literature Review

Foreign body ingestion is a common problem encountered at gastroenterology clinics and emergency rooms which can cause serious complications. Usually, foreign bodies are directly visible with flexible endoscopes and can be readily removed. However, when foreign bodies migrate into the deeper tissue of the esophagus, surgery is typically required. There is currently no consensus regarding the best treatment. In this report, we present two cases in which fish bones embedded in the submucosal and muscularis propria of the esophagus were successfully removed via endoscopic submucosal dissection (ESD). Both patients were discharged without any complications.

Successful endoscopic extraction of a proximal esophageal foreign body following accurate localization using endoscopic ultrasound: A case report

BACKGROUND

It is rare to find fish bones completely embedded in the wall of the esophagus with endoscopic findings similar to those of submucosal tumors. Most of the patients had the foreign body removed by thoracotomy or thoracoscopy in the past, which resulted in great trauma.

CASE SUMMARY

We report a 58-year-old woman who experienced dysphagia for 6 d after eating fish. Cervical computed tomography (CT) and endoscopic ultrasonography (EUS) indicated a fish bone completely embedded in the wall of the esophagus with endoscopic findings similar to those of submucosal tumors. The results of CT reconstruction and EUS suggested that the fish bone was parallel to the longitudinal axis of the esophagus. We performed a longitudinal mucosal incision from the highest point of the uplift by using an Olympus dual knife to find the fish bone. Unfortunately, no fish bone was found, so we extended the incision and endoscopic submucosal dissection (ESD) technique was used to detect and remove the fish bone entirety.

CONCLUSION

The extraction of fish bone via ESD immediately after the injection of methylene blue into the submucous membrane under EUS guidance to obtain accurate localization of the foreign body may be the best treatment for such patients.