A Prospective Study on Fish Bone Ingestion

Abstract

A prospective study was performed on 358 patients to examine the diagnosis, management, and natural history of fish bone ingestion. All patients admitted with the complaint had a thorough oral examination. Flexible endoscopy under local pharyngeal anesthesia would be performed on patients with negative findings. Of 117 fish bones encountered, 103 were removed (direct removal, 21; endoscopic removal, 82) and 12 were inadvertently dislodged. One was missed and the other one necessitated removal with rigid laryngoesophagoscopy under general anesthesia. Morbidity (1%) occurred in patients with triangular bones in the hypopharynx, resulting in one mucosal tear and two lengthy procedures. Mean hospital stay was 7 hours. Prediction of the presence of fish bones by symptoms and radiograph was poor. The location of symptoms, however, was useful in guiding the endoscopist to the site of lodgment. Of patients who refused endoscopy, only one (2.8%) developed retropharyngeal abscess. As compared to those who received endoscopy, 31.8% had fish bones detected. As the yield of fish bone detected was also inversely related to the duration of symptoms, we strongly suspect that most of the unremoved fish bones would be dislodged and passed. However, because of the serious potential complication from fish bone ingestion, we believe that a combination of oral examination followed by flexible endoscopy is indicated in all patients. When triangular bones in the hypopharynx are encountered, rigid laryngoesophagoscopy should be considered. This protocol had safely and effectively dealt with the present series of patients.

Successful treatment of a hepatic abscess that formed secondary to fish bone penetration by laparoscopic removal of the foreign body: report of a case

“…[12] Endoscopy may be helpful if performed before foreign body migration and mucosal healing. [7] In our case, endoscopy was not helpful for the event had taken place considerably a long time ago. Ultrasonography and CT may help to diagnose these unusual presentations of migrating foreign bodies and plan the management.…”

“…[6] Gastrointestinal perforation have been reported in less than 1% of the cases and may cause peritonitis, localized abscess or inflammatory mass, bleeding or fistula. [1,7] In some cases, pancreatitis, appendicitis, and liver abscesses have been reported. [8][9][10] Hepatic foreign bodies are rare.…”

Foreign Body Ingestion in a Patient with Psychiatric Illness

“…Most true foreign bodies can be identified radiographically, however in case of nonradiodense and some radiodense foreign bodies, native x-ray examination may not be sufficient to exclude ingestion of a foreign body [6]. Ngan et al showed a sensitivity of only 32% and a specificity of 91% for ingested fish bones in native x-ray films of 354 patients [7]. Small foreign bodies, may be concealed by fluids and soft tissue masses.…”

Case of an intrahepatic sewing needle and review of the literature

“…Other manifestations include peritonitis, localized abscess or inflammatory mass, bleeding, or fistula. [2,28] CT, colonoscopy, and surgical exploration are all useful to examine FB in the gastrointestinal tract. [29] According to the literature, presence of sewing needle in the right liver lobe has been documented in 9 cases and in the left liver lobe in 11 cases.…”