Liver Abscess Due to Migrated Foreign Body

Liver abscess secondary to a migrated foreign body (fish bone) is a rare entity where early diagnosis helps in management and thereby improves the prognosis. We present a unique case of a 47-year-old hypertensive man who presented with high-grade fever, chills, rigors, and abdominal pain. On evaluation, he was found to have a liver abscess secondary to a foreign body (fish bone), although no history of foreign body ingestion was recalled by the patient. Drainage of liver abscess and removal of the foreign body comprise the treatment of choice. We report the successful management of a patient with liver abscess from a migrated fish bone. This case underscores the importance of considering foreign body ingestion as a potential cause of liver abscess, even when patients cannot recall such an event. Timely diagnosis and intervention, along with advances in imaging techniques, contribute to successful outcomes in these rare but challenging cases.

Use of Endoscopy to Remove Fish Bone that Caused Sigmoid Colon Perforation

An 87-year-old man experiencing lower abdominal discomfort resulting from the ingestion of a fish bone underwent conservative management involving endoscopic extraction of the fish bone lodged in the sigmoid colon. Most patients with lower gastrointestinal tract perforations typically develop peritonitis or abscesses, necessitating surgical intervention. Notably, endoscopic management of lower gastrointestinal tract perforations is infrequently employed. Patients presenting with localized abdominal symptoms along with a stable overall health condition may benefit from conservative therapeutic approaches that utilize endoscopic methods. Notably, the transition from endoscopic procedures for foreign body removal to surgical intervention requires close collaboration with a surgeon and must be executed judiciously.

Combination of gastroscopy and fibro‑bronchoscopy facilitates removal of incarcerated fish bone in the esophagus: A case report

Esophageal foreign body impaction is a notable clinical emergency. If the high-risk esophageal foreign bodies are not removed in time, life-threatening complications, such as perforation, infection and injury to the vessels, may occur. In the present study, the case of a patient experiencing a foreign body sensation in the throat after ingesting a fish bone by mistake is presented. A high risk of impending arterial puncture was confirmed using thoracic CT and thoracic aorta CT angiography scanning. The ends of the fish bone were first confirmed using a fibro-bronchoscopy light source passing through the bronchial and esophageal walls, before biopsy forceps were used to successively free the thoracic aorta and bronchial ends under gastroscopy. Finally, the fish bone was safely removed using a combination of gastroscopy and the rarely used fibro-bronchoscopy, and the patient recovered well after standard care. In certain cases of foreign bodies, it is necessary to use multiple strategies in a timely manner according to the type and location of the ingested foreign body.

Fabrication of a Fish-Bone-Inspired Inorganic-Organic Composite Membrane

Biological materials have properties like great strength and flexibility that are not present in synthetic materials. Using the ribs of crucian carp as a reference, we investigated the mechanisms behind the high mechanical properties of this rib bone, and found highly oriented layers of calcium phosphate (CaP) and collagen fibers. To fabricate a fish-rib-bone-mimicking membrane with similar structure and mechanical properties, this study involves (1) the rapid synthesis of plate-like CaP crystals, (2) the layering of CaP-gelatin hydrogels by gradual drying, and (3) controlling the shape of composite membranes using porous gypsum molds. Finally, as a result of optimizing the compositional ratio of CaP filler and gelatin hydrogel, a CaP filler content of 40% provided the optimal mechanical properties of toughness and stiffness similar to fish bone. Due to the rigidity, flexibility, and ease of shape control of the composite membrane materials, this membrane could be applied as a guided bone regeneration (GBR) membrane.

Patterns description of hyperostosis observed in Atlantic moonfish Selene setapinnis and lookdown Selene vomer

Hyperostosis manifests itself and develops differently in taxonomically related species. Radiographic images of individuals belonging to different size classes of Atlantic Moonfish Selene setapinnis and Lookdown Selene vomer were obtained from two different estuarine areas of Rio de Janeiro/Brazil. In S. setapinnis, hyperostosis occurred in 65.22% of the specimens analyzed in three different skeletal regions. All specimens of S. vomer had hyperostosis in four regions. Patterns of occurrence were detected in both species, and the affected regions did not coincide in the same bone region, except for the cleithrum. Hyperostosis in S. setapinnis were observed in high frequencies of seventh dorsal pterygiophore, whereas in specimens of S. vomer this condition was detected to a greater extent in the neural spines of the second abdominal vertebra and first to third caudal vertebrae. The data demonstrated a relationship between the sexual maturity and the occurrence and development of hyperostotic bones in ageing process of individuals. It is the first description of S. vomer with a hyperostosis phenomenon for the species on the Brazilian coast.

Exploring the Anti-Cancer Effects of Fish Bone Fermented Using Monascus purpureus: Induction of Apoptosis and Autophagy in Human Colorectal Cancer Cells

Fish bone fermented using Monascus purpureus (FBF) has total phenols and functional amino acids that contribute to its anti-oxidant and anti-inflammatory properties. Colorectal cancer, one of the most prevalent cancers and the third largest cause of death worldwide, has become a serious threat to global health. This study investigates the anti-cancer effects of FBF (1, 2.5 or 5 mg/mL) on the cell growth and molecular mechanism of HCT-116 cells. The HCT-116 cell treatment with 2.5 or 5 mg/mL of FBF for 24 h significantly decreased cell viability (p < 0.05). The S and G2/M phases significantly increased by 88-105% and 25-43%, respectively (p < 0.05). Additionally, FBF increased the mRNA expression of caspase 8 (38-77%), protein expression of caspase 3 (34-94%), poly (ADP-ribose) polymerase (PARP) (31-34%) and induced apoptosis (236-773%) of HCT-116 cells (p < 0.05). FBF also increased microtubule-associated protein 1B light chain 3 (LC3) (38-48%) and phosphoinositide 3 kinase class III (PI3K III) (32-53%) protein expression, thereby inducing autophagy (26-52%) of HCT-116 cells (p < 0.05). These results showed that FBF could inhibit HCT-116 cell growth by inducing S and G2/M phase arrest of the cell cycle, apoptosis and autophagy. Thus, FBF has the potential to treat colorectal cancer.

Parietal mass caused by a fish bone: case report

It is a great challenge to distinguish the parietal inflammation, centered on the foreign body that pierced the digestive tract and remained in the wall before surgery, because of its atypical clinical nature. Ingestion of foreign bodies is not uncommon. Fish bones are particularly notorious culprits; however, most will pass through the gastrointestinal tract uneventfully.

Patients and Methods

The authors report a case of a patient who presented with periumbilical abdominal pain and a computed tomography (CT) scan that revealed the presence of periumbilical fat infiltration on a foreign body admitted on the Department of Digestive Cancer Surgery and Liver Transplantation, Casablanca, Morocco. An exploratory laparotomy revealed a parietal mass centered by a fish bone.

Results

Accidental ingestion of foreign bodies is common in clinical practice. However, perforation of the intestine by a foreign body is less common because the majority of foreign bodies pass without incident into the feces and only 1% of them (the sharpest and most elongated objects) will perforate the gastrointestinal tract, usually at the level of the ileum.CT, especially multidetector CT, is considered the method of choice for preoperative diagnoses of ingested foreign bodies and their complications due to its high-quality multiplanar capabilities and high resolution.Foreign body ingestion usually goes unnoticed, but the complications of this incident can be severe.

Conclusion

This case report highlights the fact that intestinal perforation caused by an ingested foreign body is a difficult diagnosis that should always be suspected in an attack of abdominal pain. Frequently, the clinical diagnosis is difficult, and recourse to imaging is sometimes necessary. Most of the time, the treatment is only surgical.

Preparation, Characterization, and Biological Properties of Hydroxyapatite from Bigeye Snapper (Priancanthus tayenus) Bone

The optimum condition of acid hydrolysis for hydroxyapatite extraction from bigeye snapper (Priancanthus tayenus) bone and the effects of extraction time (10-60 min) and HCl concentration (2.0-5.0% w/v) on yield and hydroxyapatite properties were determined. The optimum extracted condition was found using 5% HCl for 60 min, which was 13.4% yield; 19.8 g/100 g Ca content; 9.6 g/100 g P content; 2.1 Ca/P ratio; L*, a*, b*; and ΔE as 84.5, 2.8, 16.5, and 15.6, respectively. The using of 5% NaOH solution was optimum for hydroxyapatite precipitation from the extracted solution. The characteristic and biological properties of the obtained hydroxyapatite were studied. Fourier transform infrared spectroscopy and X-ray diffraction results showed a good comparison between the extracted and commercial hydroxyapatite. The microstructure of the extracted hydroxyapatite from a scanning electron microscope showed an irregular and flat-plate shape, large surface area, and roughness. The extracted hydroxyapatite was non- and low-cytotoxicity at a concentration of 50 and 100-400 µg/mL, respectively. Bovine serum albumin (BSA) adsorption and desorption of hydroxyapatite was studied. An increasing BSA concentration, hydroxyapatite amount, and adsorption time significantly increased protein adsorption on hydroxyapatite. Protein desorption from BSA-loaded hydroxyapatite showed an increase of release initially in the first 4 days and became a steady release rate until 14 days.

The clinical assessment of foreign body ingestions: Experience in a developing country

Foreign body (FB) ingestion is an important emergency in low- to middle-income countries. Our study sought to identify which clinical and radiological findings best predict upper gastrointestinal FB impaction. Amongst 149 adolescents and adults presenting to two Jamaican hospitals between 2018 and 2020, FB's were found at 31% of telescopic laryngoscopies and 60% of rigid oesophagoscopies. Commonest sites of impaction were the tonsils at laryngoscopy (15/46) and proximal oesophagus at oesophagoscopy (17/22). Odds of pharyngeal impaction were higher with fish bone ingestion, persistent discomfort, perceived location of discomfort above the cricoid cartilage and symptoms noted during a meal. Persistent discomfort and FB shadow on X-ray imaging produced higher odds of oesophageal impaction. Simple clinical and radiological assessments are useful in predicting FB impaction in resource-limited settings.

Unusual Pancreatic Abscess Secondary to Embedded Fish Bone: A Challenging Clinical Scenario

The incidental ingestion of fish bone is common, and the ingested fish bone mostly exits the gastrointestinal tract spontaneously. However, severe complications such as perforation in the digestive tract and abscess formation after a period of time may occasionally occur. Fewer than 10 cases of a migrated fish bone penetrating into the pancreas have been reported in the literature, and the development of a subsequent pancreatic abscess is extremely rare. We present one such rare case of pancreatic abscess formation in a middle-aged woman due to fish bone penetration through the gastric wall into the pancreas 2 months after ingestion and missed on endoscopy initially. Further imaging revealed that the fish bone was partially embedded in the pancreatic head surrounded with abscesses and was smoothly removed through laparoscopy.

Migration of a Fish Bone From the Esophagus to the Thyroid Gland

Accidental swallowing of fish bone is one of the most common emergencies in the otolaryngology department. The impacted fish bones are usually found in the palatine tonsil, base of the tongue, valleculae, pyriform sinus, and esophagus, which can be successfully removed after a thorough examination. However, in some cases, the fish bone may penetrate into the neck soft tissue and migrate to extraluminal organs, causing infection, abscess formation, or rupture of vessels. In such cases, prompt recognition and immediate removal of the impacted fish bone are necessary. Herein, we report a rare case of a 60-year-old woman who had accidently swallowed a fish bone 10 days prior to visiting the outpatient department. The fiberoptic scope and head and neck computed tomography scans were obtained from the outpatient department. The fish bone was found to migrate from the upper esophagus to the left thyroid gland. First, a rigid esophageal endoscopy was performed in the operating room, but no obvious fish bone was noted over the esophagus. Finally, the fish bone was removed via exploratory cervicotomy with left-sided total lobectomy of the thyroid. The patient recovered after the operation, and there were no further complications during the 3 years of follow-up.

[Perforation of Meckel's diverticulum by a fishbone]

Meckel's diverticulum is the most common congenital defect of the gastrointestinal tract. It is most often silent or asymptomatic. However, acute abdominal signs of obstruction, inflammation, hemorrhage and perforation are possible in other cases. Different foreign bodies can cause perforation of Meckel's diverticulum. We present an 18-year-old male who presented to the emergency department with abdominal pain within 48 previous hours. After evaluation, acute appendicitis was diagnosed and he underwent laparoscopic appendectomy. Meckel's diverticulum perforated by a fish bone was intraoperatively discovered. Incidental appendectomy and segmental resection of the ileum were performed.

Evaluation of Chemical Compositions, Antioxidant Capacity and Intracellular Antioxidant Action in Fish Bone Fermented with Monascus purpureus

Fish bones (FBs) are aquatic by-products that are sources of antioxidant-active peptides, calcium dietary supplements, and biomedical materials. Usually, fermentation of these by-products via microorganisms brings desirable changes, enhancing their value. This study investigates the value addition of FB when fermented with Monascus purpureus (MP) for different time intervals, such as 3 days (F3) and 6 days (F6). The results indicate that the soluble protein, peptide, amino acid and total phenol content, as well as the antioxidant capacity (DPPH, ABTS⁺ radical scavenging activity, and relative reducing power), of F3 and F6 were significantly increased after fermentation. Furthermore, the ROS contents of F3 and F6 were reduced to a greater extent than that of hydrogen peroxide (H₂O₂) in Clone-9 cells. The MMP integrity, as well as the SOD, CAT, and GPx activity, of F3 and F6 were also increased significantly compared to the H₂O₂ in Clone-9 cells. Notably, F3 and F6 displayed significant reductions in ROS content, as well as elevate, SOD activity and MMP integrity in Clone-9 cells, when compared with the native FB. These results indicate that the FBs fermented with MP for 3 days (F3), and 6 days (F6) have antioxidant capacity, with possible applications as natural food supplements.

Two cases of gastric penetration by fish bones with differing courses

Most foreign bodies swallowed accidentally are naturally excreted. Gastric penetration by a fish bone is rare due to anatomical and physiological features such as the thick stomach wall, wide lumen and gastric acid. The most common penetration site is the antral region. The clinical course of fish bone penetration of the gastric antrum may differ depending on the direction of penetration. In this report, two cases of gastric perforation by fish bones that followed different courses are presented. One case was treated conservatively with antibiotics alone, and another case was considered for surgery, due to increased hematoma and penetration of the fish bone into the pancreas. However, the patient's comorbidities were so severe that surgery was not possible, resulting in meticulous follow-up. Diagnostic imaging was important in these cases.

Diagnostic Performance of Conventional X-ray for Detecting Foreign Bodies in the Upper Digestive Tract: A Systematic Review and Diagnostic Meta-Analysis

Foreign body (FB) ingestion is a common clinical problem in acute settings. Detecting FBs in the upper digestive tract is challenging. The conventional X-ray is usually the first-line imaging tool to detect FBs. However, its diagnostic performance is inconsistent in the literature. In this study, we performed a systematic review and meta-analysis to determine the diagnostic performance of the conventional X-ray for detecting FBs in the upper digestive tract. We conducted a systematic search of PubMed, Embase, Cochrane Library, Web of Science, and Scopus until 1 August 2020. Prospective or retrospective studies investigating the diagnostic accuracy of conventional X-rays for detecting FBs in the upper digestive tract in patients of all ages were included. The Quality Assessment of Studies of Diagnostic Accuracy-2 tool was used to review the quality of included studies. We used a bivariate random-effects model to calculate diagnostic accuracy parameters. Heterogeneity was assessed using I² statistics. We included 17 studies (n = 4809) in the meta-analysis. Of the 17 studies, most studies were rated as having a high risk of bias. Conventional X-rays had a pooled sensitivity of 0.58 (95% confidence interval [CI] = 0.36–0.77, I² = 98.52) and a pooled specificity of 0.94 (95% CI = 0.87–0.98, I² = 94.49) for detecting FBs in the upper digestive tract. The heterogeneity was considerable. The area under the summary receiver operating characteristic curve was 0.91 (95% CI = 0.88–0.93). Deek’s funnel plot asymmetry test results revealed no significant publication bias (p = 0.41). The overall sensitivity and specificity of conventional X-rays were low and high, respectively, for detecting FBs in the upper digestive tract. Hence, conventional X-rays to exclude patients without upper FBs in the digestive tract are not recommended. Further imaging or endoscopic examinations should be performed for at-risk patients.

Successful laparoscopic management of a hepatic abscess caused by a fish bone

BACKGROUND

Hepatic abscess is a rare condition but comes with heavy consequences if not diagnosed and managed properly. Early detection of this pathology is challenging because of the variety and lack of specificity of symptoms but is necessary for accurate management.

CASE REPORT

We report a case of pyogenic liver abscess secondary to the migration of an ingested fish bone in a 74-year-old female. We used laparoscopic surgery to drain the abscess, remove the foreign body responsible and look for the perforation site. Parenteral antibiotherapy was added to the surgical treatment.

CONCLUSION

Early diagnosis of hepatic abscess caused by the migration of a foreign body remains a challenge. In our opinion, laparoscopic surgery associated with antibiotics is the safest and most effective therapeutic option.

Clinical presentation, diagnosis and management of aerodigestive tract foreign bodies in the adult population: Part 1

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.

Laparoscopic removal of a fishbone migrating from the gastrointestinal tract to the pancreas

Laparoscopic surgery can be performed safely for the removal of a foreign body embedded in the pancreas and should be preferred instead of open surgery, whenever possible.

A tolerable alternative for removal of a fish bone to the pharynx: A case report

Aerodigestive tract fish bones are common and often utilize significant hospital resources. Some pharyngeal fish bones can be retrieved with basic equipment thus clinicians should exhaust all simple techniques including that described in this paper.

Fish bone perforation mimicking colon cancer: A case report

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.

Migrated fish bone induced liver abscess: medical management

Liver abscess secondary to a migrated ingested foreign body is an uncommon condition where early diagnosis helps management and improves prognosis. Abscess drainage with removal of the foreign body is the recommended management. We report the successful management of a patient with a liver abscess from a migrated fishbone that was treated medically with the foreign body left in situ.

Case report of abdominal left upper quadrant collection secondary to fish bone perforation

We present an unusual case of an intra-abdominal collection which evidenced a rare etiology and raises diagnostic particularities.

Background

Fish bones ingestion is frequent, but seldom followed by complications. Those are often reported at specific sites.

Objectives

This case report emphasizes the unusual presentation and site localization of a colonic perforation by a small fish bone, in the context of limited radiological accuracy at the diagnostic phase.

Case presentation

A 37 year old male was admitted to the gastroenterology ward with upper and left sided abdominal pain associated with fever and marked fatigue. His medical history was marked by a sleeve gastrectomy in 2010 for obesity. Abdominal signs and elevated acute inflammatory syndrome on blood tests were followed by computer tomography which revealed a pericolic mass near the left splenic flexure. The pain and fever increased in intensity, so a laparotomy was proposed. Intraoperatively, a tumor-like lesion was found and a resection with oncologic limits was performed. Microscopic examination of the specimen revealed a fish bone, but only after surgery did the patient confirm that he had eaten fish meal the week before. The post-operative period was uneventful.

Conclusion

Fish bones remain some of the most frequently ingested alimentary foreign bodies; they may cause atypical clinical presentations, frequently omitted by the patients themselves if symptoms appear delayed. They could also lead to possible high-risk complications which need to be addressed by surgeons.

Clinical diagnosis and treatment of throat foreign bodies under video laryngoscopy

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.

Ingested Fish Bone Lodged in the Vallecula

Although foreign body ingestions are less common in adults than children, when they do occur, it is often due to a fish or chicken bone. The authors present a case of a fish bone ingestion, and highlight its appearance on imaging.

Ingested a fish bone-induced ileal perforation: A case report

INTRODUCTION

Gastrointestinal perforation due to foreign body intake is rare and often secondary to unintentional intake; hence, a misdiagnosis is likely. Herein, we report a case of perforation of the ileum due to fish bone.

CASE PRESENTATION

A 57-year-old woman presented with right lower abdominal pain. She did not provide any information about having a history of swallowing foreign bodies. Surgery for uterine fibroids and subtotal gastrectomy was performed 6 years ago.

DIAGNOSIS

Laboratory tests and imaging examination showed normal results. During laparotomy, a fish bone was found at the end of the ileum. Two senior radiologists re-evaluated the computed tomography scan, and confirmed the presence of the suspected foreign body.

INTERVENTIONS

Partial intestinal resection and manual ileum end anastomosis were performed.

OUTCOMES

The patient recovered well after surgery and recalled that she had eaten fish the night before experiencing abdominal pain.

CONCLUSION

An accurate diagnosis of complications due to fish bone intake, often secondary to the unintentional intake, is quite challenging. Detailed history-taking about the patient's diet and eating habits is therefore important. Clinical manifestations are mainly determined by the location of perforation, which typically occurs at the junction of the ileum and rectal sigmoid colon. Imaging examination and surgery are often used for definite diagnosis.

Laparoscopic removal of an ingested fish bone from the head of the pancreas: case report and review of literature

Most ingested foreign bodies pass spontaneously through the gastrointestinal tract and only 1% of them can perforate or penetrate the wall of stomach and duodenum and migrate into organs, such as the liver and pancreas. We report herein the case of a 59-year-old woman who presented to the emergency department with epigastric pain and fever. Computed tomography of the abdomen revealed a linear foreign body that perforate the posterior wall of the prepyloric region of the stomach. The foreign body was removed laparoscopically in one piece and was identified as a 3-cm-long fish bone. The patient recovered without complications and was discharged on the 4th postoperative day. Pancreatic foreign body is a rare entity and laparoscopic removal is warranted in majority of cases.

Case report: Ultrasound diagnosis of fish bone penetration into the thyroid

Ultrasonography is useful in the diagnosis of foreign body migrations (eg, fish bones) into the soft tissues of the neck.

Laparoscopic diagnosis and extraction of an ingested fish bone that penetrated the stomach: A case report

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.

Bone Causing Abdominal Groans

Gastrointestinal complications secondary to fish bone ingestion are rare, however important to recognize in timely manner to prevent morbidity and mortality. Diagnosis is often challenging in setting of non-specific and variable symptoms and lack of history of fish bone ingestion. Diagnostic imaging particularly computed tomography is crucial for diagnosis. However, emphasis should be given on identifying underlying cause of abdominal complications because fish bone is often missed unless specifically looked for. Identification of fish bone is essential for extraction of the inciting nidus. Emergency physician should be aware of this entity to identify it and triage the patients in timely manner. We describe here cases of sub-capsular liver abscess and acute cholecystitis caused by fish bone ingestion. The fish bone as a cause of these complication was initially missed in emergency.

Endoscopic Ultrasound-guided Drainage of a Mediastinal Abscess Caused by an Ingested Fish Bone

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. Although highly invasive, surgery is often used as the first-line treatment. We herein report the case of a 65-year-old woman who presented with complaints of progressive odynophagia and dysphagia for 2 weeks following a fish meal. Enhanced cervicothoracic computed tomography demonstrated an enhanced round mass with peripheral contrasted margins. The mass was diagnosed as a mediastinal abscess resulting from esophageal perforation caused by a fish bone. Endoscopic ultrasound-guided abscess drainage (EUS-AD) was performed using a nasobiliary drainage tube (NDT). Two weeks later, the abscess had completely disappeared. EUS-AD was safe and effective in this case; furthermore, external drainage using NDT was suitable for this abscess located very close to the upper esophageal sphincter.

Liver abscess caused by ingestion of fishbone: A case report

RATIONALE

The penetration of a foreign body through the stomach wall and causing liver abscess is rare. A case of liver abscess caused by secondary bacterial infection was reported in the current study.

PATIENT CONCERNS

A 58-year-old male patient had a history of eating fish and presented with recurrent fever with chills. The patient had a previous fever for 9 days without any obvious inducement and the highest body temperature rose to 40.8°C, along with fear of cold and chills. Body temperature declined to normal value after 5 days of infusion treatment (drugs were unknown) in the local clinic. Two days afterward, his body temperature again rose to 40.3°C at its highest.

DIAGNOSIS AND INTERVENTION

Abdominal computed tomography (CT) showed that there was a quasicircular low-density focus in the left hepatic lobe which was most likely a liver abscess. A dense strip was found in proximity to the left hepatic lobe, implying the retention of a catheter in the upper abdominal cavity or a foreign body. On conditions of related preoperative preparations and general anesthesia, the left hepatic lobe was resected with the laparoscope. During the operation, a fish bone was found in the liver. Postoperative symptomatic and supportive treatment was carried out without antibiotics for liver protection.

OUTCOMES

The patient was cured through surgical treatment and found to be in a good condition. The patient was successfully discharged and recovered well in the follow-up visit 3 months after the operation.

LESSONS

Liver abscess caused by fish spines is rare. The contrast-enhanced CT of the abdomen and the minimally invasive abdominal operation both played critical roles in the diagnosis and treatment of the case. The general population, who mistakenly eat fish bones, should seek medical treatment as soon as possible.

Sudden Unexpected Death Due to Left Subclavian Artery-esophageal Fistula Caused by Fish Bone

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.

Properties of bone from Catfish heads and frames

The objective of this paper was to evaluate methods of producing purified Catfish bone fractions from Catfish frames and heads and determine the composition of the purified bone fraction. Fresh samples of Catfish frames and heads were obtained from a large commercial Catfish processor. Triplicate samples were processed for all treatments. Two methods were developed to remove nonbone tissue from the frames: (a) use of a proteolytic enzyme to digest the nonbone tissues and (b) after boiling the frames, removal of the nonbone tissues with high-pressure water. The ash, protein, and lipid contents of unprocessed dried frames were 17%, 33%, and 41%, respectively. After the enzymatic or high-pressure water treatment processes, the frame bone compositions for the two processes were 62% and 54% ash, 35% and 33% protein, and 9% and 2% lipid, respectively. Bone from both processing treatments had a calcium content of 21%-25%, phosphorus content of 10%-11%, and contents of magnesium, manganese, zinc, and nickel were increased. Hydroxyproline content increased from 4% of the amino acids in the untreated bone to 7%-8% for the processed treatments. Tissues were removed from Catfish heads by digestion with a proteolytic enzyme and collection of the bone with a sieve. After the longest digestion period, dried head bone was 51% ash, 38% protein, and 7% lipid. The amino acid profiles showed high levels of hydroxyproline and lower levels of many essential amino acids. With increased enzymatic hydrolysis time, percent calcium and phosphorus increased. Results from this study will be used in the development of new value-added food and feed ingredients from Catfish bone.

C-MAC® video-laryngoscope assisted removal of pediatric upper airway foreign body via apneic technique: Two case reports

C-MAC® video-laryngoscope is often used by anesthetists in difficult intubation scenarios primarily in adults. Using this C-MAC® device in two of our pediatric cases, we successfully removed the laryngeal foreign body, while the anesthetist provided the apneic technique. A systematic review of PubMed and Google Scholar for similar cases was conducted. We found only one such case report of pediatric airway foreign body removal via video-laryngoscope in the English literature. The use of this high-quality, magnified video-laryngoscope in children in an emergency scenario is often not adequately applied. This procedure provides continuous real-time visualization to both the operating surgeon as well as the anesthetist in respect to the airway and thereby reduces the chance of any untoward complications. Here, we present two interesting case reports of C-MAC® video-laryngoscope assisted removal of laryngeal foreign body via apneic technique with spontaneous ventilation performed on two different children in our facility. Both these children had clinical symptoms of upper airway obstruction with fluctuating stridor simulating croup or asthma.

Cricoid ridge ossification mimicking ingested fish bone on plain radiography: prevalence in Singapore

INTRODUCTION

Ossification of the cricoid ridge mimicking impacted upper aerodigestive tract fish bone has been described in several case reports. We performed this study to determine the prevalence of such ossification in an adult population from Singapore and to identify specific imaging features that may aid in differentiating patients with cricoid ridge ossification from those with an upper aerodigestive tract impacted fish bone.

METHODS

We retrospectively evaluated 442 lateral neck radiographs of patients aged 16 years and above that were taken at the adult emergency department at National University Hospital, Singapore, during the four-month period between 1 September 2014 and 31 December 2014.

RESULTS

Ossification of the cricoid ridge mimicking fish bone appeared in 3.2% of our adult patients and was more common among patients aged above 40 years (n = 11/227; 4.8%). The ossified cricoid ridge was usually located at the C6 level (n = 9) and had a mean length of 5.5 (range 2-9) mm.

CONCLUSION

Ossified cricoid ridges may be misinterpreted on lateral neck radiography as ingested fish bones. While ossification of the cricoid ridge mimicking fish bones is rare, awareness of such ossification would reduce unnecessary further investigations of the upper aerodigestive tract in patients suspected of having an impacted foreign body.

Successful treatment of an acute infective endocarditis secondary to fish bone penetrating into left atrium caused by Granulicatella adiacens and Candida albicans: A case report

RATIONAL

Infective endocarditis caused by a foreign body of the upper digestive tract is rare. We report a rare case of Granulicatella adiacens and Candida albicans coinfection acute endocarditis combined with systematic embolization caused by a fish bone from the esophagus penetrating into the left atrium.

PATIENT CONCERN

A 42-year-old woman was admitted to our hospital because of fever, abdominal pain, headache, and right limb weakness.

DIAGNOSES

Clinical examination indicated endocarditis and systemic embolisms secondary to a fish bone from the esophagus penetrating into the left atrium. The emergency surgery confirmed the diagnosis. Cultures of blood and vegetation show G adiacens and C albicans.

INTERVENTIONS

Antimicrobial therapy lasted 6 weeks after surgery.

OUTCOMES

The patient was discharged with excellent condition7 weeks after hospitalization and was well when followed 6 months later.

LESSONS

The successful treatment of this patient combines quick diagnosis, timely surgery, and effective antimicrobial regimen. This rare possibility should be kept up in mind in acute infective endocarditis cases.

A rare case of a sharp foreign body on the vocal cord

A foreign body (FB) in the upper aerodigestive tract is a common clinical problem that presents as as acute emergency. Sharp FB, such as fish bone or chicken bone, commonly lodges in the tonsil, base of tongue, vallecula or pyriform fossa. Dislodgement of a FB into the laryngopharynx is very rare and specifically onto the vocal cord is extremely uncommon. This case report illustrates a rare case of a sharp FB that was dislodged into the airway and stuck on to the right vocal cord, which was removed under local anaesthesia.

Ancient DNA reveals the Arctic origin of Viking Age cod from Haithabu, Germany

Knowledge of the range and chronology of historic trade and long-distance transport of natural resources is essential for determining the impacts of past human activities on marine environments. However, the specific biological sources of imported fauna are often difficult to identify, in particular if species have a wide spatial distribution and lack clear osteological or isotopic differentiation between populations. Here, we report that ancient fish-bone remains, despite being porous, brittle, and light, provide an excellent source of endogenous DNA (15-46%) of sufficient quality for whole-genome reconstruction. By comparing ancient sequence data to that of modern specimens, we determine the biological origin of 15 Viking Age (800-1066 CE) and subsequent medieval (1066-1280 CE) Atlantic cod (Gadus morhua) specimens from excavation sites in Germany, Norway, and the United Kingdom. Archaeological context indicates that one of these sites was a fishing settlement for the procurement of local catches, whereas the other localities were centers of trade. Fish from the trade sites show a mixed ancestry and are statistically differentiated from local fish populations. Moreover, Viking Age samples from Haithabu, Germany, are traced back to the North East Arctic Atlantic cod population that has supported the Lofoten fisheries of Norway for centuries. Our results resolve a long-standing controversial hypothesis and indicate that the marine resources of the North Atlantic Ocean were used to sustain an international demand for protein as far back as the Viking Age.

A prospective study of epidemiological risk factors for ingestion of fish bones in Singapore

INTRODUCTION

Ingestion of fish bones is a common clinical complaint among adult patients. The aim of this study was to evaluate the epidemiological and behavioural risk factors for fish bone ingestion.

METHODS

Between 2009 and 2010, a physician-administered questionnaire was administered to 112 consecutive patients who presented to the emergency department of an adult tertiary hospital with the complaint of fish bone ingestion.

RESULTS

The wearing of dentures, the use of utensils to eat fish and the practice of deboning fish in one's mouth were found to be associated with an increased risk of fish bone ingestion.

CONCLUSION

To prevent the occurrence of fish bone ingestion and its possible complications, at-risk populations should be advised on the precautions to take when eating boned fish.

Proposal for methods of diagnosis of fish bone foreign body in the Esophagus

OBJECTIVE

To investigate the methods of diagnosis of fish bone foreign body in the esophagus and suggest a diagnostic protocol.

STUDY DESIGN

Prospective cohort study.

METHODS

A prospective study was performed on 286 patients with a history of fish bone foreign body impaction. Among them, 88 patients had negative findings in the oral cavity and laryngopharynx. Subsequent radiologic assessment of these patients included plain radiography and computed tomography (CT). Sixty-six patients showed positive findings in the esophagus, and an attempt was made to remove the obstruction using transnasal esophagoscopy.

RESULTS

In 66 patients, a fish bone foreign body was detected in the esophagus by CT. In contrast, plain radiography detected a foreign body in only 30 patients. The overall detection rate of plain radiography compared with CT for fish bones was 45.5%. Plain radiography detected 35.9% of the simple type fish bones and 54.5% of the gill bone detected by CT. However, jaw bones had a detection rate of 100% with both methods. The fish bone foreign bodies were most commonly located in the upper esophagus (n=65, 98.5%), followed by the lower esophagus (n=1, 1.5%).

CONCLUSION

CT is a useful method for identification of esophageal fish bone foreign bodies. Therefore, CT should be considered as the first-choice technique for the diagnosis of esophageal fish bone foreign body.

LEVEL OF EVIDENCE

4.

Proposal for methods of diagnosis of fish bone foreign body in the Esophagus

OBJECTIVE

To investigate the methods of diagnosis of fish bone foreign body in the esophagus and suggest a diagnostic protocol.

STUDY DESIGN

Prospective cohort study.

METHODS

A prospective study was performed on 286 patients with a history of fish bone foreign body impaction. Among them, 88 patients had negative findings in the oral cavity and laryngopharynx. Subsequent radiologic assessment of these patients included plain radiography and computed tomography (CT). Sixty-six patients showed positive findings in the esophagus, and an attempt was made to remove the obstruction using transnasal esophagoscopy.

RESULTS

In 66 patients, a fish bone foreign body was detected in the esophagus by CT. In contrast, plain radiography detected a foreign body in only 30 patients. The overall detection rate of plain radiography compared with CT for fish bones was 45.5%. Plain radiography detected 35.9% of the simple type fish bones and 54.5% of the gill bone detected by CT. However, jaw bones had a detection rate of 100% with both methods. The fish bone foreign bodies were most commonly located in the upper esophagus (n=65, 98.5%), followed by the lower esophagus (n=1, 1.5%).

CONCLUSION

CT is a useful method for identification of esophageal fish bone foreign bodies. Therefore, CT should be considered as the first-choice technique for the diagnosis of esophageal fish bone foreign body.

LEVEL OF EVIDENCE

4.

Identification of the cause of severe skin infection by Fournier transform infrared spectroscopy: a case of Fournier's gangrene caused by fish bone

Fournier's gangrene (FG) is an infrequent but highly lethal infection. Here we report a 74-year-old man who presented with genital swelling and severe malaise. Based on the physical and imaging examination results, the diagnosis of FG was confirmed. Intraoperative findings showed dirty necrosis of soft tissue, and a splinter-shaped foreign body was found in the perirectal region. The foreign body was thought to be the cause of the condition, and it was analyzed using Fourier transform infrared spectroscopy. We found that the foreign body was a mixture of calcium phosphate and protein, suggesting that the splinter was a bone. Moreover, during the medical interview, the patient mentioned about intake of fish around the time of onset of symptoms. Therefore, to confirm the results of the analysis, DNA was extracted from the foreign body, and genomic PCR with subsequent sequence analysis was performed. The DNA sequence was identical to that of Oncorhynchus kisutch, a salmon that is a very popular food in Japan. On the basis of these findings, we concluded that FG in this case was caused by the penetration into the rectum of an accidentally ingested fish bone. Although some cases of intra-abdominal abscess due to accidental ingestion of fish bone have been reported, FG caused by fish bone is extremely rare.

Liver hilar abscesses secondary to gastrointestinal perforation by ingested fish bones: surgical management of two cases

Several hepatobiliary complications secondary to gastrointestinal perforation after ingestion of a fish bone have been described in the literature, the most common being liver abscess, which can be potentially fatal. Treatment involves removal of the foreign body if possible (endoscopically or surgically), drainage of the abscess (radiologically or surgically), and appropriate antibiotic therapy. To our knowledge, no cases of hepatic hilar abscesses secondary to gastrointestinal perforation by a fish bone have been described in the literature. We report surgical management of two cases of abscess localized in the hepatic hilum secondary to the ingestion of fish bones.

Fish bone foreign bodies in the pharynx and upper esophagus: evaluation with 64-slice MDCT

BACKGROUND

Fish bone (FB) is one of the common causes of foreign body impaction in the pharynx and esophagus.

PURPOSE

To investigate the efficacy of 64-slice multidetector computed tomography (MDCT) for the evaluation of pharynx and upper esophageal FB foreign bodies.

MATERIAL AND METHODS

Sixty-six patients with suspected FB foreign body ingestion were examined by plain radiography (n = 40) and unenhanced MDCT (n = 66). We analyzed the presence, location, size, shape, and lying position of the foreign bodies.

RESULTS

On MDCT, 46 foreign bodies were detected. Among them, 45 were confirmed by endoscopy. The sensitivity of MDCT for the detection of foreign bodies was 100%, which was superior to that of the plain radiography (51.7%). The location of the foreign bodies was most common in the upper esophagus (n = 22, 47.8%), followed by pharyngoesophageal junction (n = 10, 21.7%), transjunctional (n = 7, 15.2%), hypopharynx (n = 5, 10.9%), and oropharynx (n = 2, 4.3%). Their longest length was 5.3-40.1 mm (mean, 21.3 mm). Thirty-three FBs (71.7%) were linear and 13 (28.3%) were flat in shape. They showed transverse (n = 23, 50.0%), parallel (n = 13, 28.3%), and oblique positions (n = 10, 21.7%) to the long axis of the pharynx and esophagus, respectively.

CONCLUSION

MDCT is useful for the evaluation of the pharynx and upper esophageal FB foreign bodies.