Supraglottitis secondary to oesophageal fish bone impaction

IntroductionForeign 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.ObjectiveThis study aimed to establish the factors affecting the radio-opacity of fish bones on X-ray.Materials and methodsThe 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.ResultsNo 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.ConclusionThe 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.

A sharp, impacted fish bone in the esophagus is an indication for urgent endoscopy. Endoscopic removal of such an object is a challenging task. An endoscopic protector hood is then used to remove the object. However, an endoscopic hood protector is not always available. In a patient with a large hiatal hernia, the protector hood may not return to the original shape when it passes through the gastroesophageal junction and therefore may not properly protect the esophageal mucosa from the sharp foreign body. In our case, it was impossible to deploy the endoscopic hood protector through the gastroesophageal junction despite multiple attempts. We propose an alternative solution for such cases. We safely removed a large sharp-edged flat fish bone that was folded and compressed using a detachable snare after releasing and pushing the fish bone into the stomach using an endoscope equipped with a transparent cap used for dilating the esophageal wall. This method of using an endoscopic cap and detachable snare is a safe, useful alternative for endoscopically removing a large sharp-edged flat foreign body from the upper gastrointestinal tract. This alternative technique has not been reported in the English medical literature.

Although esophageal perforation due to foreign body is uncommon, it is a lethal problem that requires careful management because of severe complications such as mediaslinilis, empyema, tracheobronchial fistula and retroperitoneal abscess. A 77-year-old man suddenly developed right upper quadrant pain after eating fish (Chromis notata) in the morning the day before admission. Upper endoscopy revealed a 4 cm-sized fishbone impaction and it was removed by a biopsy forcep. Esophageal perforation was found at the middle esophagus. Chest computed tomography showed pneumomediastinum in the left paraaortic area, paraesophageal area, and retrothyroid area. The patient was treated with total parenteral nutrition and broad spectrum intravenous antibiotics. On the seventh day of admission, he was completely recovered and esophagogram showed no leakage of contrast dye. We report an esophageal perforation and pneumomediastinum by a fishbone (Chromis notata) impaction as popular local dish in Jeju island, which was treated successfully with conservative management.

A 23-year-old woman presented to the emergency department (ED) with a sensation of a ‘fish bone’ stuck in her throat after eating cod. On physical examination, while she reported an...

Fish bone ingestion and impaction are known to everyone. However, such benign incidences have been reported to be associated with multiple potentially life threatening complications. Anatomical features of the oesophagus forms the basis for such incidences. We report here an elderly diabetic gentleman with an unusual left retro-paraoesophageal abscess complicated with oesophageal perforation, mediastinitis and vocal cord paresis which were fundamentally caused by a migrated fish bone into the lower part of the neck requiring therapeutic external neck exploration. Management of this case and its complications are described here comprehensively.

Fish bone ingestion is a common presenting complaint to the Otorhinolaryngology clinic. In majority of the cases, the removal of visualised impacted fish bones is fairly straightforward. However, diagnostic dilemma may arise in cases of migratory fish bones as initial examination may be unsuspecting. Computed tomography (CT) of the neck has proven to be a valuable tool in identifying the presence of such foreign bodies. However, there is also a subset of patients who are asymptomatic as the fish bone migrated extra-pharyngeally and they may only present late with potentially grave consequences. Herein, we present a case of elderly female with history of fish bone ingestion who presented to us eight months later with primary complaint of huge swelling in the left side of the neck. Subsequent investigation unravelled the diagnosis of migratory fish bone causing an extensive foreign body reaction resulting in a huge granuloma. The fish bone was successfully removed with subsequent resolution of the neck swelling.

Retropharyngeal abscesses (RPAs) are rare pathologies in adults and are usually secondary to injury of the pharyngeal mucosa with migration of organisms to the retropharyngeal space. They usually present with throat pain, fever, and difficulty swallowing. Rarely, the infection can breach the boundaries of this space and extend posteriorly to involve the vertebral bodies and cause an epidural abscess, resulting in neurological deficit. We present the case of a 26-year-old lady who presented with quadriparesis 3 weeks following a fish bone impaction in her pyriform fossa, where imaging revealed an RPAs communicating with the cervical spinal epidural space through the intervertebral foramina bilaterally in addition to vertebral body osteomyelitis.

An Impacted Fish Bone in the Subglottis Manifesting as Protracted Stridor: Photodocumentation

Migratory Fish Bone Presented With Extensive Surgical Subcutaneous Emphysema: A Case Report.

Rationale:Esophageal chest pain is difficult to be identified, and the diagnosis requires a high index of clinical suspicion. Upon presentation, they are difficult to be differentiated from acute coronary syndrome (ACS) by symptomatology alone.Patient concerns:We report a 71-year-old woman with multiple risk factors for coronary heart disease who presented with acute central spastic chest pain and was diagnosed as ACS in emergency department.Diagnoses:Chest computed tomography revealed 1 radiopaque lesion over the upper-third of the esophagus. One fishbone with 3-pointed heads stuck in the esophagus was noted under esophagogastroscopic examination.Interventions:The fishbone was extracted successfully via endoscopy under general anesthesia.Outcomes:The woman was discharged uneventfully after 3 days’ hospitalization.Lessons:This case illustrates that, even in emergency, clinicians should always keep in mind the possibility of esophageal foreign body impaction when confronted with frank central chest pain without associated gastrointestinal symptoms. This holds true even in the scenario of multiple cardiovascular risk factors and absence of ingestion history.