Fish Bone Foreign Body: The Role of Imaging

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 , flexible esophagoscopy , and rigid esophagoscopy . 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.

Clinical Approaches to Migrating Ingested Foreign Bodies in the Neck

“…The CT scan is essential to evaluate the status of the foreign body and nearby structures before any surgical attempt. 1,3,4,6,8,10,11,[13][14][15]18,19 For foreign bodies with complications or that are close to great vessels and vital organs, an external approach is preferred. Consultation of cardiothoracic and/or cardiovascular surgeons is recommended in cases of mediastinitis and pulmonary and cardiovascular penetration.…”

Fishbone foreign body ingestion in duodenal papilla: a cause of abdominal pain resembling gastric ulcer

“…Fishbone is the most common foreign body among the population in Asia, the Mediterranean, and other coastal countries due to dietary habits [3]. Generally, it is recommended to remove fishbone before they pass through the pylorus, otherwise 15-35% of them may perforate the intestine [4].…”

Development of an abdominal wall abscess caused by fish bone ingestion: a case report

“…Therefore, a clinical history might not be helpful [5, 6]. Moreover, fish bone complications in the gastrointestinal tract manifest with a variety of clinical presentations, ranging from impaction in the upper gastrointestinal tract, dysphagia, bowel obstruction, and silent perforation to frank peritonitis [7]. Peritonitis can be acute or chronic.…”