1
|
Corbisiero MF, Wershoven N, Clary M, Cervenka B. Traumatic Vocal Fold Paralysis from Fishbone Foreign Body: Diagnosis and Management. Laryngoscope 2024. [PMID: 38984434 DOI: 10.1002/lary.31639] [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: 04/02/2024] [Revised: 06/08/2024] [Accepted: 07/03/2024] [Indexed: 07/11/2024]
Abstract
Fish bone foreign bodies (FFBs) are relatively common but can present diagnostic challenges. Herein, we report a case of a 43-year-old female who initially presented to the Emergency Department with fever and throat discomfort after a choking incident, which led to a misdiagnosis of a viral infection after negative chest X-ray findings. Persistent symptoms, including new-onset vocal cord paralysis, prompted further investigation and an otolaryngology - head and neck surgery referral one month later. During the otolaryngology visit eight months after the initial incident, laryngoscopy revealed left true vocal cord paralysis and a subsequent CT scan revealed a 2.3 cm fishbone in the esophagus. Surgical removal involved flexible esophagoscopy and open neck exploration with careful dissection to avoid vascular injury. This case highlights the limitations of initial diagnostic methods, such as X-rays, and the necessity for heightened clinical vigilance and advanced imaging modalities like CT scans for persistent or evolving symptoms, particularly vocal cord paralysis. This case also supports multidisciplinary surgical management in cases of suspected esophageal FFBs involving the internal jugular vein and common carotid artery to prevent serious complications. Laryngoscope, 2024.
Collapse
Affiliation(s)
| | - Nicole Wershoven
- Department of Otolaryngology - Head and Neck Surgery, University of Colorado, Aurora, Colorado, U.S.A
| | - Matthew Clary
- Department of Otolaryngology - Head and Neck Surgery, University of Colorado, Aurora, Colorado, U.S.A
| | - Brian Cervenka
- Department of Otolaryngology - Head and Neck Surgery, University of Colorado, Aurora, Colorado, U.S.A
| |
Collapse
|
2
|
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.
Collapse
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.
| |
Collapse
|
3
|
Ouédraogo RWL, Millogo M, Coulibaly TA. Unusual Intra-Thyroid Migration of Ingested Fish Bone: A Case Report and Literature Review. Indian J Otolaryngol Head Neck Surg 2024; 76:2782-2784. [PMID: 38883478 PMCID: PMC11169425 DOI: 10.1007/s12070-024-04516-y] [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: 11/03/2023] [Accepted: 01/08/2024] [Indexed: 06/18/2024] Open
Abstract
Trans-esophageal migration of foreign bodies is a rare but serious complication of vulnerable foreign bodies. This clinical case is about a 37-year-old female patient, with a history of foreign body ingestion eight (08) months ago, received for anterior cervical swelling evolving since about seven (07) months ago. The diagnosis of thyroid nodule was evoked on clinical examination and explored by neck ultrasound which confirmed the thyroid nodule and highlighted the presence of an intra-thyroid fish bone. The extraction was carried out by cervicotomy under general anesthesia after fine needle markup and the evolution under medical treatment was favorable after 03 weeks. Extra-digestive migrations of ingested foreign bodies constitute often a source of diagnostic wandering and therapeutic difficulties due to their polymorphous clinical manifestations. This was the case in our context where it was confused with an authentic thyroid pathology. Its take of care often imposed neck surgery which could be avoided by earlier endoscopy. Vulnerable foreign bodies of the esophagus must imperatively be extracted for avoiding trans-esophageal migrating.
Collapse
Affiliation(s)
- Richard Wend-Lasida Ouédraogo
- Department of Oto Rhino Laryngology, University Hospital Sanou Sourô, Bobo-Dioulasso, Burkina Faso
- Higher Institute of Health Sciences, Nazi Boni University, Bobo-Dioulasso, Burkina Faso
| | - Mathieu Millogo
- Higher Institute of Health Sciences Joseph Ki-Zerbo University, Ouagadougou, Burkina Faso
| | - T Antoine Coulibaly
- Department of Oto Rhino Laryngology, University Hospital Sanou Sourô, Bobo-Dioulasso, Burkina Faso
- Higher Institute of Health Sciences, Nazi Boni University, Bobo-Dioulasso, Burkina Faso
| |
Collapse
|
4
|
Han JH, Cha RR, Kwak JY, Jeon H, Lee SS, Jung JJ, Cho JK, Kim HJ. Two Cases of Severe Complications Due to an Esophageal Fish Bone Foreign Body. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1504. [PMID: 37763623 PMCID: PMC10533137 DOI: 10.3390/medicina59091504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/08/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023]
Abstract
Cases of foreign body ingestion are encountered relatively often in clinical settings; however, serious complications are rare. In such cases, mediastinal abscess due to esophageal perforation can become a life-threatening complication. We encountered two cases of severe complications due to an esophageal fish bone foreign body. The first case was a 40-year-old male with an intramural esophageal abscess due to a fish bone after eating fish five days before visiting the hospital. The patient underwent surgical treatment, but the esophageal abscess did not improve; so, the abscess was drained through endoscopic mucosal dissection, and the abscess improved. In the second case, a 64-year-old male, who had eaten fish three days before visiting the hospital, had esophageal perforation by a fish bone, and abscess formation in the mediastinum and the lesser sac in the abdominal cavity were observed. Although surgical treatment was performed, the intra-abdominal abscess formation was not controlled; so, percutaneous drainage (PCD) was inserted, and the abscess improved. Both patients were discharged without any complications. Here, we report two cases that were improved through surgical treatments and additional treatments such as endoscopic dissection and PCD.
Collapse
Affiliation(s)
- Ji-Hee Han
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Jinju 52828, Republic of Korea; (J.-H.H.); (J.-Y.K.); (H.J.); (S.-S.L.); (H.J.K.)
| | - Ra-Ri Cha
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Jinju 52828, Republic of Korea; (J.-H.H.); (J.-Y.K.); (H.J.); (S.-S.L.); (H.J.K.)
| | - Ji-Yoon Kwak
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Jinju 52828, Republic of Korea; (J.-H.H.); (J.-Y.K.); (H.J.); (S.-S.L.); (H.J.K.)
| | - Hankyu Jeon
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Jinju 52828, Republic of Korea; (J.-H.H.); (J.-Y.K.); (H.J.); (S.-S.L.); (H.J.K.)
| | - Sang-Soo Lee
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Jinju 52828, Republic of Korea; (J.-H.H.); (J.-Y.K.); (H.J.); (S.-S.L.); (H.J.K.)
| | - Jae Jun Jung
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Jinju 52828, Republic of Korea;
| | - Jin Kyu Cho
- Department of General Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju 52828, Republic of Korea;
| | - Hyun Jin Kim
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Jinju 52828, Republic of Korea; (J.-H.H.); (J.-Y.K.); (H.J.); (S.-S.L.); (H.J.K.)
| |
Collapse
|
5
|
Xiong SZ, Sha T, Liu W. An unusual cause of dysphagia: Esophageal external compressive stricture caused by abscess. Am J Med Sci 2023; 365:e29-e30. [PMID: 36162451 DOI: 10.1016/j.amjms.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/09/2022] [Accepted: 09/19/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Shi-Ze Xiong
- The First College of Clinical Medical Science, China Three Gorges University, Yichang, China; Institute of Digestive Disease, China Three Gorges University, Yichang, China.; Department of Gastroenterology, Yichang Central People's Hospital, Yichang, China
| | - Tong Sha
- The First College of Clinical Medical Science, China Three Gorges University, Yichang, China; Institute of Digestive Disease, China Three Gorges University, Yichang, China.; Department of Gastroenterology, Yichang Central People's Hospital, Yichang, China
| | - Wei Liu
- The First College of Clinical Medical Science, China Three Gorges University, Yichang, China; Institute of Digestive Disease, China Three Gorges University, Yichang, China.; Department of Gastroenterology, Yichang Central People's Hospital, Yichang, China..
| |
Collapse
|
6
|
Nellipudi JA, Seow K, Tharion J. Fishbone in the pleural space: an unusual case of pleural empyema. ANZ J Surg 2022; 92:3328-3329. [PMID: 35229463 DOI: 10.1111/ans.17576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 02/05/2022] [Accepted: 02/16/2022] [Indexed: 12/31/2022]
Affiliation(s)
- Jessy A Nellipudi
- Department of Cardiothoracic Surgery, The Canberra Hospital, Canberra, Australian Capital Territory, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Kevin Seow
- Department of Radiology, The Canberra Hospital, Canberra, Australian Capital Territory, Australia.,Fellow of the Royal Australian and New Zealand College of Radiologists, Sydney, New South Wales, Australia.,European Board of Interventional Radiology, Vienna, Austria
| | - John Tharion
- Department of Cardiothoracic Surgery, The Canberra Hospital, Canberra, Australian Capital Territory, Australia.,Fellow of the Royal Australasian College of Surgeons, Melbourne, Victoria, Australia
| |
Collapse
|
7
|
Hsieh JW, Dulguerov N, Mermod M. Mediastinal abscess revealed by computed tomography after pharyngeal fish-bone impaction. Radiol Case Rep 2022; 17:4478-4480. [PMID: 36189151 PMCID: PMC9519490 DOI: 10.1016/j.radcr.2022.09.012] [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: 08/22/2022] [Revised: 08/29/2022] [Accepted: 09/04/2022] [Indexed: 11/29/2022] Open
Abstract
Fishbone impactions in the upper aerodigestive tract are frequent but rarely cause serious complications when recognized and treated early. In this report, we describe the case of a patient that sought medical attention as late as 2 weeks after the fishbone impaction. A 52-year-old male was presented with fever, odynophagia and a toxic appearance. CT scan revealed a large cervicomediastinal abscess. The patient was immediately started on large-spectrum antibiotics, treated by surgical drainage, and recovered uneventfully. This case report highlights the occurrence of severe complications of upper digestive tract fishbone impaction and the usefulness of a preoperative CT scanner in this context.
Collapse
|
8
|
Ear, Nose, and Throat Foreign Bodies in Children: A Retrospective Study. CHILDREN 2022; 9:children9010063. [PMID: 35053688 PMCID: PMC8774108 DOI: 10.3390/children9010063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/30/2021] [Accepted: 01/02/2022] [Indexed: 11/17/2022]
Abstract
Background: This study analyzed the presentation, characteristics, and management of foreign bodies in different age groups of pediatric patients with ear, nose, and throat foreign bodies. Methods: A retrospective study was performed using data from October 2012 to September 2020. A total of 1285 patients with ear, nose, and throat foreign bodies who were less than 12 years of age and who presented to the emergency room were included in this study. Their biographical data, clinical presentations, foreign body types and locations, and management outcomes were obtained from medical records and analyzed as three age groups (infancy: <2 years old; early childhood: 2–5 years old; and late childhood: 6–12 years old). Results: The early childhood group had the highest number of patients (n = 672; 52.2%). Throat was the most common location (59.2%), and bone was the most common type of foreign body. Among the children who visited our hospital, foreign bodies were actually found in only 657 patients (51.1%) and removed by an otolaryngologist in 625 (95.1%) cases. Conclusion: Our study could provide guidance for the diagnosis and management of pediatric patients who present to emergency departments with foreign bodies.
Collapse
|
9
|
Conthe A, Payeras Otero I, Pérez Gavín LA, Baines García A, Usón Peiron C, Villaseca Gómez C, Herrera Fajes JL, Nogales Ó. ESOPHAGEAL FISH BONE IMPACTION: THE IMPORTANCE OF EARLY DIAGNOSIS AND TREATMENT TO AVOID SEVERE COMPLICATIONS. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2022; 114:660-662. [DOI: 10.17235/reed.2022.8537/2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
10
|
Dong T, Tao Y, Wu R, Fan W, Wang L, Zhao L, Liu L, Fan Z. Endoscopy-negative esophageal foreign body - The role of computed tomography. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2022; 114:503-504. [DOI: 10.17235/reed.2022.8770/2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
11
|
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.
Collapse
Affiliation(s)
- Jirapa Chansangrat
- School of Radiology, Medical Institute, Suranaree University of Technology, Nakhon Ratchasima, Thailand
| |
Collapse
|
12
|
Li SY, Miao Y, Cheng L, Wang YF, Li ZQ, Liu YB, Zou TM, Shen J. Surgical treatment of delayed cervical infection and incomplete quadriplegia with fish-bone ingestion: A case report. World J Clin Cases 2021; 9:7535-7541. [PMID: 34616823 PMCID: PMC8464462 DOI: 10.12998/wjcc.v9.i25.7535] [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: 02/23/2021] [Revised: 04/20/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The most commonly ingested foreign body in Asians is fish bone. The vast majority of patients have obvious symptoms and can be timely diagnosed and treated. Cases of pyogenic cervical spondylitis and diskitis with retropharyngeal and epidural abscess resulting in incomplete quadriplegia due to foreign body ingestion have been rarely reported. The absence of pharyngeal or esophageal discomfort and negative computed tomography (CT) findings of fish bone have not been reported. We report the case of an elderly female patient with delayed cervical infection and incomplete quadriplegia who had a history of fish bone ingestion.
CASE SUMMARY A 73-year-old woman presented with right neck pain and weakness of four limbs for a week, and had a history of fish bone ingestion and negative findings on laryngoscopic examination one month previously. She did not complain of any pharyngeal or esophageal discomfort. Cervical magnetic resonance imaging showed C4/C5 spondylitis and diskitis along with retropharyngeal and ventral epidural abscesses. No sign of fish bone was detected on lateral cervical radiography and CT scans. The muscle strength of the patient’s right lower limb receded to grade 1 and other limbs to grade 2 suddenly on the 10th day of hospitalization. Emergency surgery was performed to drain the abscess and decompress the spinal cord by removing the anterior inflammatory necrotic tissue. Simultaneously, flexible esophagogastroduodenoscopy was carried out and a hole in the posterior pharyngeal wall was found. The motor weakness of the right lower limb improved to grade 3 and the other limbs to grade 4 within 2 d postoperatively.
CONCLUSION This rare case highlights the awareness of the posterior pharyngeal or esophageal wall perforation in patients with cervical pyogenic spondylitis along with a history of fish bone ingestion, even though local discomfort symptoms are absent and the radiological examinations are negative.
Collapse
Affiliation(s)
- Suo-Yuan Li
- Department of Orthopaedic Surgery, the Affiliated Suzhou Hospital of Nanjing Medical University; Suzhou Municipal Hospital, Suzhou 215000, Jiangsu Province, China
| | - Ye Miao
- Department of Orthopaedic Surgery, the Affiliated Suzhou Hospital of Nanjing Medical University; Suzhou Municipal Hospital, Suzhou 215000, Jiangsu Province, China
| | - Liang Cheng
- Department of Orthopaedic Surgery, the Affiliated Suzhou Hospital of Nanjing Medical University; Suzhou Municipal Hospital, Suzhou 215000, Jiangsu Province, China
| | - Ye-Feng Wang
- Department of Orthopaedic Surgery, the Affiliated Suzhou Hospital of Nanjing Medical University; Suzhou Municipal Hospital, Suzhou 215000, Jiangsu Province, China
| | - Zhi-Qiang Li
- Department of Orthopaedic Surgery, the Affiliated Suzhou Hospital of Nanjing Medical University; Suzhou Municipal Hospital, Suzhou 215000, Jiangsu Province, China
| | - Yu-Bo Liu
- Department of Orthopaedic Surgery, the Affiliated Suzhou Hospital of Nanjing Medical University; Suzhou Municipal Hospital, Suzhou 215000, Jiangsu Province, China
| | - Tian-Ming Zou
- Department of Orthopaedic Surgery, the Affiliated Suzhou Hospital of Nanjing Medical University; Suzhou Municipal Hospital, Suzhou 215000, Jiangsu Province, China
| | - Jun Shen
- Department of Orthopaedic Surgery, the Affiliated Suzhou Hospital of Nanjing Medical University; Suzhou Municipal Hospital, Suzhou 215000, Jiangsu Province, China
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Kumar D, Venugopalan Nair A, Nepal P, Alotaibi TZ, Al-Heidous M, Blair Macdonald D. Abdominal CT manifestations in fish bone foreign body injuries: What the radiologist needs to know. Acta Radiol Open 2021; 10:20584601211026808. [PMID: 34377536 PMCID: PMC8330480 DOI: 10.1177/20584601211026808] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/02/2021] [Indexed: 01/08/2023] Open
Abstract
Fish bone is one of the most common foreign body ingestions encountered in the emergency department. Fish bone perforations occur most commonly in segments with acute angulation like the ileocecal region and rectosigmoid junction and can present acutely with obstruction and free air or with chronic complications like abscess and sepsis. Radiologists should be familiar with the high-risk clinical scenarios, the CT appearance of radiopaque fishbones, and the spectrum of imaging findings related to gastrointestinal (GI) tract so as to direct management and timely referral to GI endoscopists and surgeons.
Collapse
Affiliation(s)
- Devendra Kumar
- Department of Clinical Imaging, Al Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Pankaj Nepal
- Department of Radiology, St Vincent's Medical Center, Bridgeport, CT, USA
| | - Tariq Za Alotaibi
- Department of medical imaging, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Mahmoud Al-Heidous
- Department of Clinical Imaging, Al Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
| | - David Blair Macdonald
- Department of Radiology, University of Ottawa, Ottawa, ON, Canada.,Department of Medical Imaging, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| |
Collapse
|
15
|
Alreefi M, Althawadi N, Patel A, Dwivedi R. A rare case of a migrating fishbone lodged in the larynx for 6 months in a patient with delayed presentation due to COVID-19 pandemic. J Surg Case Rep 2021; 2021:rjab131. [PMID: 34025966 PMCID: PMC8128398 DOI: 10.1093/jscr/rjab131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/13/2021] [Indexed: 01/06/2023] Open
Abstract
A foreign body sensation following fishbone ingestion is a common presentation to the Accident and Emergency Department. Simple removal is achieved with acute presentations and accessible locations. The risk of complications increases with delay in seeking medical attention. We report a case of a migratory fishbone lodged in the larynx for 6 months in a patient with delayed presentation due to COVID-19 pandemic
Collapse
Affiliation(s)
- Mohamed Alreefi
- Head and Neck Surgery Department, University College London Hospital, London, UK
| | - Noora Althawadi
- Head and Neck Surgery Department, University College London Hospital, London, UK
| | - Ankit Patel
- Head and Neck Surgery Department, University College London Hospital, London, UK
| | - Raghav Dwivedi
- Head and Neck Surgery Department, University College London Hospital, London, UK
| |
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
Wang Y, Luo X, Zhang J. Successful laparoscopic treatment for sustained abdominal pain due to fish bone migrating into the neck of the pancreas: a case report and thinking about surgical approach through the literature review. Surg Case Rep 2021; 7:91. [PMID: 33851276 PMCID: PMC8044272 DOI: 10.1186/s40792-021-01174-y] [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: 03/09/2021] [Accepted: 04/06/2021] [Indexed: 11/12/2022] Open
Abstract
Background The majority of ingested foreign bodies pass through the gastrointestinal tract smoothly, with less than 1% requiring surgery. Fish bone could perforate through the wall of stomach or duodenum and then migrate to other surrounding organs, like the pancreas and liver. Case presentation We report herein the case of a 67-year-old male who presented with sustained mild epigastric pain. Abdominal computed tomography revealed a linear, hyperdense, foreign body along the stomach wall and pancreatic neck. We made a final diagnosis of localized inflammation caused by a fish bone penetrating the posterior wall of the gastric antrum and migrating into the neck of the pancreas. Upper gastrointestinal endoscopy was performed firstly, but no foreign body was found. Hence, a laparoscopic surgery was performed. The foreign body was removed safely in one piece and was identified as a 3.2-cm-long fish bone. The patient was discharged from the hospital on the fifth day after surgery without any postoperative complications. Conclusion Laparoscopic surgery has proven to be a safe and effective way to remove an ingested fish bone embedded in the pancreas.
Collapse
Affiliation(s)
- Yang Wang
- Hepatic Biliary and Pancreatic Cancer Center, Chongqing University Cancer Hospital, No. 181 Hanyu Road, Shapingba, Chongqing, 400030, People's Republic of China
| | - Xianzhang Luo
- Hepatic Biliary and Pancreatic Cancer Center, Chongqing University Cancer Hospital, No. 181 Hanyu Road, Shapingba, Chongqing, 400030, People's Republic of China
| | - Jiefeng Zhang
- Hepatic Biliary and Pancreatic Cancer Center, Chongqing University Cancer Hospital, No. 181 Hanyu Road, Shapingba, Chongqing, 400030, People's Republic of China.
| |
Collapse
|
18
|
Garg N, Lee RN, Pekmezaris R, Gupta S. An Assessment of Management Strategies for Adult Patients with Foreign-Body Sensation in the Neck. J Emerg Trauma Shock 2021; 14:28-32. [PMID: 33911433 PMCID: PMC8054801 DOI: 10.4103/jets.jets_131_19] [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] [Received: 12/01/2019] [Revised: 08/12/2020] [Accepted: 10/21/2020] [Indexed: 11/25/2022] Open
Abstract
Objectives: Patients come to the emergency department (ED) for the evaluation of foreign-body sensation in the neck. Given the dearth of clinical studies for this complaint, these patients are treated subjectively by different providers. We aim to propose a treatment approach that results in the timely diagnosis and removal of foreign bodies by comparing the common radiologic studies used in the ED for this complaint, determining the utility of consults, and providing an approach that minimizes length of stay. Methods: We conducted a retrospective cohort study of adults between January 2014 and December 2015 presenting to LIJ and NSUH EDs with a chief complaint of foreign-body sensation in the pharynx, larynx, or esophagus. Fifty unique cases were studied. Consultations with ear, nose, and throat (ENT) and/or gastrointestinal, any imaging studies used, and time until discharge from the hospital were the primary exposures studied. The time for each diagnostic path for successful removal of a foreign body was compared for each case. Results: Three common diagnostic approaches were identified. The most common pathway (six cases) had an ENT consult for removal of the foreign body, with an average time to discharge of 188 min. Another common pathway (four cases) began with a neck X-ray followed by an ENT consult, with an average time of 327 min. The third common approach (6 cases) involved no imaging studies or consults, with an average time of 166 min. Neck X-ray (20 cases) was found to have a sensitivity of 43% and a specificity of 83%. The sensitivity of neck computed tomography (CT) (15 cases) had a sensitivity of 91% and a specificity of 50%. Chest X-ray (15 cases) was found to have a sensitivity of just 17%. Chest CT (3 cases) had a sensitivity of 67%. Conclusion: Based on our data, we recommend that an attempt to localize the foreign body be completed by the emergency physician. If an initial attempt does not resolve the sensation, an ENT consult to remove the possible object should be initiated. Only after failure by ENT should radiological imaging be considered.
Collapse
Affiliation(s)
- Nidhi Garg
- Department of Emergency Medicine, Southside Hospital, Bay Shore, New York, USA
| | - Ryan N Lee
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra University, Hempstead, New York, USA
| | - Renee Pekmezaris
- Department of Medicine, Northwell Health, Manhasset, New York, USA
| | - Sanjey Gupta
- Department of Emergency Medicine, Southside Hospital, Bay Shore, New York, USA
| |
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
Qiu Y, Xu S, Wang Y, Chen E. Migration of ingested sharp foreign body into the bronchus: a case report and review of the literature. BMC Pulm Med 2021; 21:90. [PMID: 33731031 PMCID: PMC7968162 DOI: 10.1186/s12890-021-01458-x] [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: 10/18/2020] [Accepted: 03/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background Foreign body ingestion is a common emergence in gastroenterology. Foreign bodies are most likely to be embedded in the esophagus. The sharp ones may penetrate the esophageal wall and lead to serious complications. Case presentation A 72-year-old Chinese female was admitted to our hospital with a 4-day history of retrosternal pain and a growing cough after eating fish. Chest computed tomography scan indicated that a high-density foreign body (a fish bone) penetrated through the esophageal wall and inserted into the left main bronchus. First, we used a rigid esophagoscope to explore the esophagus under general anesthesia. However, the foreign body was invisible in the side of the esophagus. Then, the fiberoptic bronchoscopy was performed. We divided the fish bone, which traversed the left main bronchus, into two segments under holmium laser and removed the foreign body successfully. The operation time was short and there were no complications. The patient was discharged 1 week postoperatively and was symptom free even under a liquid diet. Conclusions There are several challenges in the management of this rare condition. We applied the technique of interventional bronchoscopy to the management of esophageal foreign body flexibly in an emergency. A surgery was avoided, which was more invasive and costly.
Collapse
Affiliation(s)
- Yuanhua Qiu
- Department of Respiratory and Critical Care Medicine, Regional Medical Center for National Institute of Respiratory Disease, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Shan Xu
- Department of Respiratory and Critical Care Medicine, Regional Medical Center for National Institute of Respiratory Disease, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Yafang Wang
- Department of Respiratory and Critical Care Medicine, Regional Medical Center for National Institute of Respiratory Disease, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Enguo Chen
- Department of Respiratory and Critical Care Medicine, Regional Medical Center for National Institute of Respiratory Disease, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
| |
Collapse
|
21
|
Investigative strategies for fish bone foreign bodies during the coronavirus disease 2019 pandemic: an analysis of ENT UK guidelines. The Journal of Laryngology & Otology 2021; 135:250-254. [PMID: 33632367 PMCID: PMC7948105 DOI: 10.1017/s0022215121000669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background By nature of their specialty, otolaryngologists are disproportionately exposed to coronavirus disease 2019 through aerosol-generating procedures and close proximity to the oropharynx during examination. Methods Our single-centre, retrospective study analysed the pertinence of guidelines produced by ENT UK to improve the investigation and management of suspected upper aerodigestive fish bone foreign bodies during the coronavirus disease 2019 pandemic. Results Our results demonstrated 43.3 per cent (n = 13) low-risk cases and 56.7 per cent (n = 17) moderate-risk cases. Nine fish bones (two low risk, seven moderate risk) were found; none of these were confirmed with X-ray and three (moderate risk) required nasoendoscopy for diagnosis. One patient required rigid pharyngoscopy. Conclusion This study confirms that soft tissue neck X-ray and flexible nasoendoscopy are unnecessary in low-risk cases; however, early nasoendoscopy in higher suspicion cases is appropriate. Recommendations are made about the long-term sustainability of these guidelines, and additional measures are encouraged that relate to repeat attendances and varying prevalence of coronavirus disease 2019 in the hospital catchment area.
Collapse
|
22
|
Drobyazgin EA, Chikinev YV, Arkhipov DA. [Diagnostic and treatment of foreign bodies of the upper digestive tract]. Khirurgiia (Mosk) 2021:38-44. [PMID: 34029034 DOI: 10.17116/hirurgia202106138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To evaluate the results of diagnosis and treatment of foreign bodies of the upper gastrointestinal tract. MATERIAL AND METHODS There were 1187 patients aged 15-99 years with suspected foreign body of the upper gastrointestinal tract. In 536 patients (266 men, 270 women), foreign bodies were detected. Ingestion of a foreign body was more common in patients aged 46-65 years. In 516 patients, foreign bodies were detected in the esophagus (pharyngo-esophageal junction - 25, upper third of the esophagus - 426, middle third of the esophagus - 34, lower third of the esophagus - 21, esophageal-gastric junction - 10). Four patients admitted with esophageal wall perforation. In 3 cases, foreign bodies were localized in the throat, 15 patients - in the stomach, 2 patients - in the duodenum. RESULTS In most cases, foreign bodies were organic (n=506). Removal was successful in 530 cases. In 4 patients with esophageal wall perforation and mediastinitis, removal was performed intraoperatively. Flexible endoscope was used in 500 cases. In 86 patients, foreign bode was displaced in the stomach using flexible endoscopy. Foreign body removing wasn't successful in 4 cases. In 2 patients, extraction was followed by esophageal wall damage. In 4 patients, esophagotomy was applied to extract foreign body. Suturing the esophageal wall defect was carried out in 2 cases. Abrasion and erosive esophagitis were the most common injuries of esophageal mucosa. Esophageal diseases were detected in 75 cases after foreign body removal (67 cases - benign esophageal diseases). One patient died from bedsore of innominate artery complicated by acute hemorrhage. CONCLUSION Foreign bodies of the upper gastrointestinal tract are observed in 45% of patients at admission. Neck and chest X-ray examination is obligatory before endoscopy. Flexible endoscopy is a gold standard for diagnosis and extraction of foreign bodies. Repeated endoscopy after foreign body extraction should be mandatory. It is necessary to visualize complications associated with foreign body and identify esophageal diseases.
Collapse
Affiliation(s)
- E A Drobyazgin
- Novosibirsk State Medical University, Novosibirsk, Russia
- State Novosibirsk Regional Clinical Hospital, Novosibirsk, Russia
- Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Yu V Chikinev
- Novosibirsk State Medical University, Novosibirsk, Russia
- State Novosibirsk Regional Clinical Hospital, Novosibirsk, Russia
| | - D A Arkhipov
- State Novosibirsk Regional Clinical Hospital, Novosibirsk, Russia
| |
Collapse
|
23
|
Penetration of a swallowed fish bone into pulmonary vein: diagnosis and management. Heliyon 2020; 6:e05611. [PMID: 33294720 PMCID: PMC7701346 DOI: 10.1016/j.heliyon.2020.e05611] [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: 10/20/2020] [Revised: 11/23/2020] [Accepted: 11/23/2020] [Indexed: 11/24/2022] Open
Abstract
We present a case of a 71-year-old woman who accidently swallowed a large fish bone that penetrated into the pulmonary vein. She visited the hospital the next day with a complaint of mild chest discomfort with slight pain and fever of 37.4 °C. Contrast-enhanced chest computed tomography (CT) scan revealed a large fish bone with a length of 35 mm impacted in the middle esophagus. The bone had penetrated into the pulmonary vein, causing mediastinitis. Blood tests revealed elevation in the white blood cell count and C-reactive protein level. Because intractable bleeding from pulmonary vein after endoscopic removal can be lethal, endoscopic removal of the fish bone in an operating room under general anesthesia with cardiovascular surgical standby for possible emergency surgery was selected. After endoscopic removal, mediastinal hematoma was absent with a follow-up chest CT scan, and the mediastinitis was treated with intravenous antibiotics. The patient shortly became afebrile with normalized blood test findings. After confirming the normal findings on the follow-up chest CT scan and endoscopic inspection in the next week, she was discharged from the hospital 10 days after hospitalization without any complications. When the swallowed bone penetrates into the major pericardial vessels, unprepared endoscopic removal may result in fatal sequelae such as intractable mediastinal hemorrhage. Urgent consultation with cardiovascular or thoracic surgeons for a possible emergent surgery is needed before endoscopic removal is attempted.
Collapse
|
24
|
Sibanda T, Pakkiri P, Ndlovu A. Fish bone perforation mimicking colon cancer: A case report. SA J Radiol 2020; 24:1885. [PMID: 33101725 PMCID: PMC7565025 DOI: 10.4102/sajr.v24i1.1885] [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] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/10/2020] [Indexed: 12/14/2022] Open
Abstract
Most patients who ingest fish bones do not develop any complications. The small proportion of patients who do complicate, present with non-specific symptoms. A 64-year-old female patient presented with a 2-month history of abdominal pain. Following clinical evaluation and computed tomography scan of the abdomen, a provisional diagnosis of colon cancer was made. Histology of the resected bowel at hemicolectomy demonstrated a perforation by fish bone with an associated abscess. The case illustrates how fish bone perforation may mislead unsuspecting clinicians and may be misdiagnosed as colonic cancer.
Collapse
Affiliation(s)
| | - Pria Pakkiri
- Department of Pathology, Baines Pathology, Harare, Zimbabwe
| | - Anne Ndlovu
- Department of Radiology, Baines Imaging Group, Harare, Zimbabwe
| |
Collapse
|
25
|
Lin C, Liu D, Zhou H, Zhang X, Lu L, Gao X. Clinical diagnosis and treatment of throat foreign bodies under video laryngoscopy. J Int Med Res 2020; 48:300060520940494. [PMID: 32686966 PMCID: PMC7372625 DOI: 10.1177/0300060520940494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective This study was designed to explore the clinical application of video
laryngoscopy in the diagnosis and treatment of throat foreign bodies
(FBs). Method In total, 1572 patients diagnosed with throat FBs at the Department of
Otolaryngology of Nanjing Drum Tower Hospital were retrospectively analysed.
The covariables collected were the time from FB ingestion to admission, age,
sex, duration of admission, and site of impaction. Result The most common FBs were fish bones, which accounted for 1446 (91.98%) of
1572 FBs. Among all 1572 FBs, 1004 (63.87%) were successfully removed by
video laryngoscopy without complications. A shorter duration of admission
was associated with a higher diagnostic rate under video laryngoscopy. The
diagnostic rate of sharp FBs was significantly higher than that of non-sharp
FBs. The most common sites of throat FBs were the tongue root (42.29%),
epiglottic vallecula (19.40%), tonsil (18.21%), and piriform fossa
(10.65%). Conclusion Video laryngoscopy is a powerful tool for the diagnosis and treatment of
throat FBs, allowing for identification of rare locations of FBs as well as
refractory FBs.
Collapse
Affiliation(s)
- Chuanyao Lin
- Department of Otolaryngology Head and Neck Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, China.,Research Institute of Otolaryngology, Nanjing, China
| | - Dingding Liu
- Department of Otolaryngology Head and Neck Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, China.,Research Institute of Otolaryngology, Nanjing, China
| | - Han Zhou
- Department of Otolaryngology Head and Neck Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, China.,Research Institute of Otolaryngology, Nanjing, China
| | - Xiaoli Zhang
- Department of Otolaryngology Head and Neck Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, China.,Research Institute of Otolaryngology, Nanjing, China
| | - Ling Lu
- Department of Otolaryngology Head and Neck Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, China.,Research Institute of Otolaryngology, Nanjing, China
| | - Xia Gao
- Department of Otolaryngology Head and Neck Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, China.,Research Institute of Otolaryngology, Nanjing, China
| |
Collapse
|
26
|
Rayudu NK, Palla S, Vaaka PHD, Rao DP. Impacted Fish Bone in Buccal Space Associated with an Abscess: Role of Point-of-care Ultrasonography in Dental Emergencies. J Med Ultrasound 2020; 29:53-56. [PMID: 34084718 PMCID: PMC8081100 DOI: 10.4103/jmu.jmu_18_20] [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: 02/03/2020] [Revised: 02/13/2020] [Accepted: 03/04/2020] [Indexed: 11/19/2022] Open
Abstract
Fish bone impaction in buccal space abscess is an uncommon dental scenario. A case of young adult with partially edentulous state contributing to this emergency is presented. The history, clinical imaging findings, surgical procedure, and checklist for clinical assessment are briefly described. The point-of-care ultrasonography (POCUS) was used in our case to identify, locate, and perform an ultrasonography-guided removal of impacted fish bone in consolidated abscess of the buccal space. The role of POCUS in cases of dental swellings or uncommon emergencies is emphasized in clinical settings.
Collapse
Affiliation(s)
- Naren Kishore Rayudu
- Department of Oral and Maxillofacial Surgery, KIMS Dental College and Hospital, Chaitanya Health City, Amalapuram, Andhra Pradesh, India
| | - Santosh Palla
- Department of Oral Medicine and Radiology, KIMS Dental College and Hospital, Chaitanya Health City, Amalapuram, Andhra Pradesh, India
| | - Phani Himaja Devi Vaaka
- Department of Oral and Maxillofacial Surgery, KIMS Dental College and Hospital, Chaitanya Health City, Amalapuram, Andhra Pradesh, India
| | - Dagilla Priyanka Rao
- Department of Radio-Diagnosis, Konaseema Institute of Medical Sciences and Research Foundation, Chaitanya Health City, Amalapuram, Andhra Pradesh, India
| |
Collapse
|
27
|
Internal Jugular Vein Injury by Fishbone Ingestion. Case Rep Med 2020; 2020:9182379. [PMID: 32636881 PMCID: PMC7321512 DOI: 10.1155/2020/9182379] [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: 12/10/2019] [Accepted: 06/01/2020] [Indexed: 11/24/2022] Open
Abstract
Fishbone ingestion is a common occurrence in the Middle East countries. We present a patient with a unique complication of fishbone ingestion. A 65-year-old woman presented with left-sided neck pain and swelling since 5 days before admission. A linear foreign body with horizontal orientation was seen in CT scan at the superior part of the pharynx along with a collection around it which caused a laceration on the medial aspect of internal jugular vein and thrombosis inside the internal jugular vein.
Collapse
|
28
|
Khoo HW, Ong CYG, Chinchure D. Teach a man to fillet: gastrointestinal and extra-gastrointestinal complications related to fish bone ingestion. Clin Imaging 2020; 69:150-157. [PMID: 32745894 DOI: 10.1016/j.clinimag.2020.06.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/29/2020] [Indexed: 11/24/2022]
Abstract
Accidental ingestion of fish bone is a common occurrence in populations that consume unfilleted fish. Although most ingested foreign bodies pass through the gastrointestinal tract uneventfully within a week, less than 1% of patients unfortunately develop gastrointestinal perforation. Occasionally, some patients who are unaware of an episode of fish bone ingestion may present sub-acutely with symptoms mimicking inflammatory conditions or pyrexia of unknown origin. Computed tomography (CT) is the definitive imaging modality in the diagnosis of fish bone foreign body and its complications. This pictorial essay aims to illustrate the various complications related to fish bone ingestion, broadly divided into gastrointestinal related complications and extra-gastrointestinal complications related to migration of fish bone. Radiologists should be familiar with the myriad of possible complications, and take heed that a relevant history of fish bone ingestion is often absent.
Collapse
Affiliation(s)
- Hau Wei Khoo
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, 11, Jalan Tan Tock Seng, 308433, Singapore.
| | - Chern Yue Glen Ong
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, 11, Jalan Tan Tock Seng, 308433, Singapore.
| | - Dinesh Chinchure
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore, 90 Yishun Central, 768828, Singapore.
| |
Collapse
|
29
|
Lim D, Ho CM. Appendicitis-mimicking presentation in fishbone induced microperforation of the distal duodenum: A case report. World J Gastrointest Surg 2020; 12:77-84. [PMID: 32128031 PMCID: PMC7044108 DOI: 10.4240/wjgs.v12.i2.77] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/18/2019] [Accepted: 12/05/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Upper gastrointestinal fishbone microperforations are rare and not commonly reported in medical literature. Despite the increasing use of computer tomography (CT) imaging and the employment of the Alvardo criteria, misdiagnosis of acute appendicitis can still occur. We report the rare case of an elderly Chinese gentleman who had a fish-bone induced microperforation of the duodenum that closely mimicked the symptoms of acute appendicitis.
CASE SUMMARY This 79-year-old man presented with migratory lower abdominal pain that localized at his periumbilical region and right lower quadrant. He had associated pyrexia, general malaise and was noted to have an elevated white cell count. CT investigations initially revealed a distended appendix which was resected laparoscopically but showed no obvious signs of gross inflammation. The patient then deteriorated clinically and had increased oxygen requirements immediately after the surgery. This prompted further investigations. A further review of his CT scan revealed a fine fishbone microperforation in the distal duodenum associated with retroperitoneal abscess formation and seepage extending into the right lower quadrant. He was then started on broad spectrum intravenous antibiotics and subsequently underwent a laparotomy 12 h later to manage the obscure aetiology and to drain the abscess. The post-operative course was uneventful and he was discharged 11 d later including a 2-d stay in the intensive care unit.
CONCLUSION This case offers an insight into a potential mimic of acute appendicitis and the diagnostic difficulties experienced in such presentations.
Collapse
Affiliation(s)
- Daniel Lim
- Department of Surgery, National Taiwan University Hospital, Taipei 100, Taiwan
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh EH16 4TJ, United Kingdom
- Victoria Hospital Kirkcaldy, NHS Lothian, South-East Scotland Deanery KY2 5AH, United Kingdom
| | - Cheng-Maw Ho
- Department of Surgery, National Taiwan University Hospital, Taipei 100, Taiwan
| |
Collapse
|
30
|
AlBathi AK, Shaaban SS, Alshadadi F, Alsheikh B, Althinayyan B, Khashoggi K, Merdad M. Radio-opacity of the Bones of Commonly Consumed Fish from the Red Sea. Cureus 2019; 11:e6473. [PMID: 31903310 PMCID: PMC6935738 DOI: 10.7759/cureus.6473] [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] [Indexed: 11/14/2022] Open
Abstract
Introduction Foreign body (FB) ingestion is one of the most common complaints presenting at an emergency department (ED), with fish bone impaction being a frequent cause of presentation. Fish bones might be challenging to identify on routine radiography and ED physicians are often left in a state of uneasiness owing to the fear of complications occurring if the fish bone is not removed. Objective This study aimed to establish the factors affecting the radio-opacity of fish bones on X-ray. Materials and methods The study involved the top three fish species consumed on Saudi Arabia’s western coast. Fish bones from three specimens of each species were radiographically examined by hand-picking bones from different parts of the fish, with particular attention paid to bones that are difficult to spot. Bones were then arranged beside each other, and radiographs were taken for comparison. Inter-species and intra-species radio-opacity variation was tested. Further, the weight of each fish and method of cooking (baked vs. fried) were tested for their effect on radio-opacity. Results No significant difference in radio-opacity was found among and between different species, and the method of cooking did not alter the radio-opacity of fish bones. Significant differences in radio-opacity were noted with the difference in the diameter and size of the fish bones, which tended to be less radio-opaque in smaller-sized fish, regardless of the species. Conclusion The exact fish species and method of cooking did not alter the fish bone density on an X-ray. The size of the fish and the size of the fish bone are better predictors of higher fish bone density.
Collapse
Affiliation(s)
- Abdullah K AlBathi
- Department of Otolaryngology - Head and Neck Surgery, King Abdulaziz University Hospital, Jeddah, SAU
| | - Saeed S Shaaban
- Department of Medicine, King Abdulaziz University Hospital, Jeddah, SAU
| | - Faisal Alshadadi
- Department of Otolaryngology - Head and Neck Surgery, King Abdulaziz University Hospital, Jeddah, SAU
| | - Bader Alsheikh
- Department of Otolaryngology - Head and Neck Surgery, King Abdulaziz University Hospital, Jeddah, SAU
| | - Basim Althinayyan
- Department of Otolaryngology - Head and Neck Surgery, King Abdulaziz University Hospital, Jeddah, SAU
| | - Khalid Khashoggi
- Department of Radiology, King Abdulaziz University Hospital, Jeddah, SAU
| | - Mazin Merdad
- Department of Otolaryngology - Head and Neck Surgery, King Abdulaziz University Hospital, Jeddah, SAU
| |
Collapse
|
31
|
Zhang Z, Wang G, Gu Z, Qiu J, Wu C, Wu J, Huang W, Shen G, Qian Z. Laparoscopic diagnosis and extraction of an ingested fish bone that penetrated the stomach: A case report. Medicine (Baltimore) 2019; 98:e18373. [PMID: 31852147 PMCID: PMC6922390 DOI: 10.1097/md.0000000000018373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
RATIONALE Foreign body ingestion is a common clinical event, but serious complication such as perforation is uncommon. Here we present a case of gastrointestinal perforation caused by fish bone, which was treated effectively and successfully by totally laparoscopic management. PATIENT CONCERNS A 63-year-old man who was admitted to our hospital with epigastric pain for 1 month. Computed tomography of the abdomen at the local hospital revealed a linear, hyperdense, foreign body in the lesser curvature of gastric antrum that had penetrated through the posterior wall of the gastric antrum. DIAGNOSIS The laparoscopic exploration found that a 2.5 cm × 0.3 cm fish bone had penetrated through the posterior wall of the gastric antrum. INTERVENTIONS A totally laparoscopic surgery was performed to remove the foreign body and repair the perforation eventually. OUTCOMES After surgery, the patient underwent uneventful recovery and was discharged on postoperative day 7. During the 3 months of follow-up visit, the patient appeared healthy and did not report abdominal symptoms. LESSONS In this case, the advantages of laparoscopic techniques in the diagnosis and treatment of gastrointestinal perforation caused by foreign body was confirmed, and which may be considered as the primary choice in similar cases.
Collapse
Affiliation(s)
- Zhi Zhang
- Department of General Surgery, Suzhou Ninth People's Hospital, Suzhou, China
| | - Gang Wang
- Department of General Surgery, Suzhou Ninth People's Hospital, Suzhou, China
| | - Zhigang Gu
- Department of General Surgery, Suzhou Ninth People's Hospital, Suzhou, China
| | - Jie Qiu
- Department of General Surgery, Suzhou Ninth People's Hospital, Suzhou, China
| | - Chuanfu Wu
- Department of General Surgery, Suzhou Ninth People's Hospital, Suzhou, China
| | - Jianzhong Wu
- Department of General Surgery, Suzhou Ninth People's Hospital, Suzhou, China
| | - Weixian Huang
- Department of General Surgery, Suzhou Ninth People's Hospital, Suzhou, China
| | - Genhai Shen
- Department of General Surgery, Suzhou Ninth People's Hospital, Suzhou, China
| | - Zhenghai Qian
- Department of General Surgery, Suzhou Ninth People's Hospital, Suzhou, China
| |
Collapse
|
32
|
Lim GC, Cho SY, Boo SJ, Kim HU. Embedded Fish Bone in the Upper Esophageal Sphincter that Was Localized and Removed Using Ultrasonography-guided Surgery. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2019. [DOI: 10.7704/kjhugr.2019.19.2.127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
33
|
Zhao S, Tinzin L, Deng W, Tong F, Shi Q, Zhou Y. Sudden Unexpected Death Due to Left Subclavian Artery-esophageal Fistula Caused by Fish Bone. J Forensic Sci 2019; 64:1926-1928. [PMID: 31162649 DOI: 10.1111/1556-4029.14092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 04/30/2019] [Accepted: 05/09/2019] [Indexed: 12/26/2022]
Abstract
A 53-year-old woman was admitted to the hospital due to unexpected dizziness and died the following morning. To investigate the cause of death, a forensic autopsy along with histological examination was performed 3 days after her death. The major findings of the autopsy were that a fish bone had pierced the left subclavian artery after perforating the esophagus with 680 mL of blood in the stomach and bloody and tarry contents were present in the intestines, and the cause of death was confirmed to be subsequent hemorrhagic shock. Unfortunately, none of her family realized that she had eaten a fish 4 days before the tragedy until the fish bone was found. The present case is rare and instructive. The histopathological findings of left subclavian artery-esophageal fistula induced by a fish bone can be used as a reference in forensic practice.
Collapse
Affiliation(s)
- Shuquan Zhao
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, China
| | - Lopsong Tinzin
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, China
| | - Weinian Deng
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, China
| | - Fang Tong
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, China
| | - Qing Shi
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, China
| | - Yiwu Zhou
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, China
| |
Collapse
|
34
|
Mima K, Sugihara H, Kato R, Matsumoto C, Nomoto D, Shigaki H, Kurashige J, Inoue M, Iwagami S, Mizumoto T, Kubota T, Miyanari N. Laparoscopic removal of an ingested fish bone that penetrated the stomach and was embedded in the pancreas: a case report. Surg Case Rep 2018; 4:149. [PMID: 30594971 PMCID: PMC6311171 DOI: 10.1186/s40792-018-0559-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 12/18/2018] [Indexed: 02/07/2023] Open
Abstract
Background The gastrointestinal tract can occasionally be perforated or penetrated by an ingested foreign body, such as a fish bone. However, there are very few reported cases in which an ingested fish bone penetrated the gastrointestinal tract and was embedded in the pancreas. Case presentation An 80-year-old male presented with epigastric pain. Computed tomography of the abdomen showed a linear, hyperdense, foreign body that penetrated through the posterior wall of the gastric antrum. There was no evidence of free air, abscess formation, migration of the foreign body into the pancreas, or pancreatitis. As the patient had a history of fish bone ingestion, we made a diagnosis of localized peritonitis caused by fish bone penetration of the posterior wall of the gastric antrum. We first attempted to remove the foreign body endoscopically, but failed because it was not detected. Hence, an emergency laparoscopic surgery was performed. A linear, hard, foreign body penetrated through the posterior wall of the gastric antrum and was embedded in the pancreas. The foreign body was safely removed laparoscopically and was identified as a 2.5-cm-long fish bone. Intraperitoneal lavage was performed, and a drain was placed in the lesser sac. The patient recovered without complications and was discharged on the 7th postoperative day. Conclusion Laparoscopic surgery could be performed safely for the removal of an ingested fish bone embedded in the pancreas.
Collapse
Affiliation(s)
- Kosuke Mima
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan.
| | - Hidetaka Sugihara
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan
| | - Rikako Kato
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan
| | - Chihiro Matsumoto
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan
| | - Daichi Nomoto
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan
| | - Hironobu Shigaki
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan
| | - Junji Kurashige
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan
| | - Mitsuhiro Inoue
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan
| | - Shiro Iwagami
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan
| | - Takao Mizumoto
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan
| | - Tatsuo Kubota
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan
| | - Nobutomo Miyanari
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan
| |
Collapse
|
35
|
Chen Q, Chu H, Tong T, Tao Y, Zhou L, Chen J, Liu Y, Peng L. Predictive factors for complications associated with penetrated fish bones outside the upper gastrointestinal tract. Eur Arch Otorhinolaryngol 2018; 276:185-191. [PMID: 30539244 DOI: 10.1007/s00405-018-5242-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 12/06/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE To investigate predictive risk factors for complications associated with migrating fish bones in the surrounding tissue of upper gastrointestinal tract. METHODS A retrospective analysis over 12 years was conducted of 45 cases of buried fish bones in the surrounding tissue of upper gastrointestinal tract with complications. Meanwhile, a control group, including 39 cases of prolonged buried fish bones in the surrounding tissue of upper gastrointestinal tract without complications, was set. Patient clinical data were collected and analyzed to predict the risk factors for complications. RESULTS The results of Chi-square test and univariate analysis both showed a significant difference in length of fish bone (> 2 cm), a history of concurrent medical illness (diabetes mellitus and renal hypofunction), symptoms (medium or heavy pain and dysphagia), and duration of significant symptoms (> 7 days) between the complication group and non-complication group. Multivariate analysis further identified length (> 2 cm), diabetes mellitus, medium or heavy pain, dysphagia, and duration of significant symptoms (> 7 days) as independent risk factors for complications. CONCLUSIONS The consequences of fish bones migrating outside the upper gastrointestinal tract are various in different people. Awareness should be raised when encountering a patient ingesting a long fish bone, having a history of diabetes mellitus, presenting with significant discomforts, or these discomforts lasting for a long time. This study will help practitioners counsel their patients on the risks and `benefits of surgery versus observation of this condition.
Collapse
Affiliation(s)
- Qingguo Chen
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, China
| | - Hanqi Chu
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, China
| | - Ting Tong
- Department of Otolaryngology-Head and Neck Surgery, Taikang Tongji (Wuhan) Hospital, Sixin North Road No. 322, Hanyang District, Wuhan, China
| | - Yanling Tao
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, China
| | - Liangqiang Zhou
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, China
| | - Jin Chen
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, China
| | - Yun Liu
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, China
| | - Liyan Peng
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, China.
| |
Collapse
|
36
|
Klein A, Ovnat-Tamir S, Marom T, Gluck O, Rabinovics N, Shemesh S. Fish Bone Foreign Body: The Role of Imaging. Int Arch Otorhinolaryngol 2018; 23:110-115. [PMID: 30647794 PMCID: PMC6331292 DOI: 10.1055/s-0038-1673631] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 07/22/2018] [Indexed: 02/07/2023] Open
Abstract
Introduction
Fish bone foreign body (FFB) impaction in the upper aerodigestive tract is a common cause for emergency department referral. Its management varies in both diagnosis and treatment paradigms. Fish bone foreign bodies are more commonly found in the oropharynx in cases of patients < 40 years old, and in the esophagus in cases of patients > 40 years old. Symptoms are typically non-indicative for the location of the FFB, with the exception of foreign body sensation at/superior to the cervical esophagus. A lack of findings during the physical examination is routinely followed by imaging, with computed tomography (CT) being the preferred modality. In practice, many patients undergo unnecessary imaging studies, including CT scans.
Objectives
To identify patients with suspected fish bone impaction who do not require CT imaging and can be safely discharged.
Data Synthesis
We have searched the PubMed database for the following medical subject headings (MeSH) terms:
fish bone
,
fish foreign body
AND
oropharynx
,
hypopharynx
,
esophagus
,
flexibleesophagoscopy
, and
rigidesophagoscopy
. Our search in the English language yielded 32 papers. Case reports were included, since they highlighted rare and serious complications.
Conclusion
In patients > 40 years old suspected of fish bone impaction, non-contrast CT is recommended and should be urgently performed, even in the presence of ambiguous symptoms. However, in patients < 40 years old presenting within 24 hours from ingestion, imaging has little diagnostic value due to the low probability of esophageal fish bones. For this specific subgroup, in the absence of clinical findings, discharge without imaging studies may be considered safe.
Collapse
Affiliation(s)
- Ayala Klein
- Department of Otolaryngology-Head and Neck Surgery, Assuta Ashdod University Hospital, Ashdod, Israel
| | - Sharon Ovnat-Tamir
- Department of Otolaryngology-Head and Neck Surgery, Assuta Ashdod University Hospital, Ashdod, Israel
| | - Tal Marom
- Department of Otolaryngology-Head and Neck Surgery, Assuta Ashdod University Hospital, Ashdod, Israel
| | - Ofer Gluck
- Department of Otolaryngology-Head and Neck Surgery, Assuta Ashdod University Hospital, Ashdod, Israel
| | - Naomi Rabinovics
- Department of Otolaryngology-Head and Neck Surgery, Assuta Ashdod University Hospital, Ashdod, Israel
| | - Shay Shemesh
- Department of Otolaryngology-Head and Neck Surgery, Assuta Ashdod University Hospital, Ashdod, Israel
| |
Collapse
|
37
|
Curran J, Qureishi A, Martinez-Devesa P. Oxford radiographic chart of foreign bodies. Clin Otolaryngol 2018; 43:1353-1357. [DOI: 10.1111/coa.13135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2018] [Indexed: 11/29/2022]
Affiliation(s)
- J.F. Curran
- NHS Foundation Trust; Oxford University Hospitals; Oxford UK
| | - A. Qureishi
- NHS Foundation Trust; Oxford University Hospitals; Oxford UK
| | | |
Collapse
|
38
|
Zhang S, Wen J, Du M, Liu Y, Zhang L, Chu X, Xue Z. Diabetes is an independent risk factor for delayed perforation after foreign bodies impacted in esophagus in adults. United European Gastroenterol J 2018; 6:1136-1143. [PMID: 30288275 DOI: 10.1177/2050640618784344] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 05/28/2018] [Indexed: 12/27/2022] Open
Abstract
Background Perforation is the most serious complication of esophageal foreign bodies. Studies examining the association between diabetes and esophageal foreign body-induced perforation are largely non-existent. Objectives The purpose of this study was to identify the risk factors for esophageal foreign body-induced perforation. Methods A retrospective chart review of patients with esophageal foreign bodies between January 2012-January 2017 was performed at the Chinese People's Liberation Army General Hospital. The patients were divided into two groups: those complicated with perforation and those without perforation. Date on patient demographics, symptoms, foreign bodies, and diabetes were collected and analyzed. Study-specific odds ratio and 95% confidence intervals (CI) were estimated using multivariable logistic regression models. Results Of 294 patients with esophageal foreign bodies (41.84% male, mean age, 56.73 years), 33 (11.22%) complicated by perforation. Diabetes (odds ratio = 6.00; 95% confidence interval = 1.72-20.23), duration (>24 h) of foreign bodies retention (odds ratio = 4.25; 95% confidence interval = 1.71-10.86), and preoperative fever (odds ratio = 8.19; 95% confidence interval = 3.17-21.74) were strongly associated with an increased risk of perforation, whereas the sensation of a foreign body (odds ratio = 0.32; 95% confidence interval = 0.09-0.92) was a protective factor of perforation. Glucose level was not observed to have an association among patients with or without perforation. Conclusions Diabetes and duration of foreign body retention increase risk for esophageal foreign bodies complicated by perforation, and cases with elevated armpit temperature may represented a more likely perforation compared with those without fever.
Collapse
Affiliation(s)
- Shaowei Zhang
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, China
| | - Jiaxin Wen
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, China
| | - Mingmei Du
- Department of Infection Management and Disease Control, Chinese PLA General Hospital, Beijing, China
| | - Yunxi Liu
- Department of Infection Management and Disease Control, Chinese PLA General Hospital, Beijing, China
| | - Lianbin Zhang
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, China
| | - Xiangyang Chu
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, China
| | - Zhiqiang Xue
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
39
|
Devaraja K, Nayak DR, Bhandarkar AM, Sharma PV. Usual suspects: the foreign bodies of the aerodigestive tract. BMJ Case Rep 2018; 2018:bcr-2018-224979. [PMID: 29930188 DOI: 10.1136/bcr-2018-224979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
This case series is about four different foreign bodies lodged in different locations of the aerodigestive tract. All four cases had delayed diagnosis due to inconspicuous history. Radiology in the form of computed tomography aided the appropriate diagnosis in most of these cases. Though all four patients have been successfully managed by removal of foreign body, not all of them have identical outcomes. A brief discussion about predictive factors in the fish bone foreign body has been included. The authors also discuss certain critical aspects of the management, which may aid in reducing the morbidity. We emphasise on the high index of suspicion in peculiar cases and on the low threshold for radiological investigation in doubtful clinical scenarios.
Collapse
Affiliation(s)
- K Devaraja
- Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Dipak Ranjan Nayak
- Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ajay M Bhandarkar
- Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Poorvi V Sharma
- Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| |
Collapse
|
40
|
Thyroid Cartilage Window Approach to Extract a Foreign Body after Migration into the Paraglottic Space. Case Rep Otolaryngol 2018; 2018:3590580. [PMID: 29808147 PMCID: PMC5902111 DOI: 10.1155/2018/3590580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 03/11/2018] [Indexed: 02/07/2023] Open
Abstract
We report a case of fish bone impaction in the paraglottic space, which caused palsy of the left vocal cord. The patient was a 45-year-old man. He presented with throat pain and hoarseness of voice for approximately one week. The diagnosis was made after careful history taking and confirmed by the use of computed tomography scan as the fish bone was not visible endoscopically under local and general anaesthesia. The patient underwent thyroid cartilage window approach, and the fish bone was retrieved. His symptoms have improved significantly, and he did not require tracheostomy. Other cases reported the removal of foreign bodies by other techniques such as laryngofissure and posterolateral approach. Our case is different in that we used a modification of thyroplasty type 1 technique as it has less reported complications than other approaches that were published in literature.
Collapse
|
41
|
Efficacy of EUS for detection of a buried fish bone in the esophagus. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2018; 3:125-126. [PMID: 29916496 PMCID: PMC6004575 DOI: 10.1016/j.vgie.2018.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
42
|
Mansouri M, Singh A. Imaging of Neck Emergencies. Emerg Radiol 2018. [DOI: 10.1007/978-3-319-65397-6_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
43
|
Boo SJ, Kim HU. Esophageal Foreign Body: Treatment and Complications. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2018; 72:1-5. [DOI: 10.4166/kjg.2018.72.1.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Sun-Jin Boo
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Heung Up Kim
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| |
Collapse
|
44
|
Zhong Q, Jiang R, Zheng X, Xu G, Fan X, Xu Y, Liu F, Peng C, Ren W, Wang L. Esophageal foreign body ingestion in adults on weekdays and holidays: A retrospective study of 1058 patients. Medicine (Baltimore) 2017; 96:e8409. [PMID: 29069038 PMCID: PMC5671871 DOI: 10.1097/md.0000000000008409] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The purpose of this study is to compare the clinicopathological characteristics and outcomes of esophageal foreign body (FB) ingestion in adults between weekdays and holidays. This is a retrospective study including 1058 patients with esophageal FB ingestion from 2012 to 2016. Patient characteristics, the types and locations of FB, and clinical outcomes were compared between patients on weekdays and holidays. Furthermore, independent risk factors of complication on weekdays and holidays respectively were evaluated. The locations of FB, underlying diseases, and complications significantly differed between weekdays and holidays groups, while no difference was found in the types of FB. Patients got higher percentage of erosion complication on holidays than that on weekdays (60.8% vs 47.6%, P < .0001). Multivariate logistic regression analysis revealed that jujube shell was a significant predictor of complication on weekdays (P < .001). However, complication was significantly associated with nonfood bolus FB ingestion on holidays (P < .001). Our data suggest that there were different clinicopathological characteristics of FB ingestion between weekdays and holidays, and more patients got complications on holidays. On holidays, a latex protector hood or an overtube should be applied to patients who swallowed nonfood bolus in order to reduce esophageal mucosal damage.
Collapse
Affiliation(s)
- Qian Zhong
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School
| | - Ruiwei Jiang
- The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Xi Zheng
- Salem Health Medical Group, Salem, OR
| | - Guifang Xu
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School
| | - Xiuqin Fan
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School
| | - Yuanyuan Xu
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School
| | - Fei Liu
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School
| | - Chunyan Peng
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School
| | - Wei Ren
- Department of Geriatric Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Lei Wang
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School
| |
Collapse
|