Migrated fish bone into the neck: a case report

Abstract

Background Impaction of foreign body is a common condition presented to ear, nose, and throat department among Asian population. The commonest foreign body seen among this population has been documented as fish bone. Fish bone can migrate to lateral neck space or related organs around the neck and chest. By presenting this case report, we aim to emphasize the importance of taking proper history and make clinicians aware of the possibility of a fish bone migrating into different spaces. This will help to prevent diagnosis delay leading to complications due to migrated fish bone. Case presentation A 50-year-old female Sinhalese patient presented to ear, nose, and throat department with right-sided neck pain for 2 days, who had a history of suspected fish bone impaction a few days ago that subsided without any investigations or treatments. She did not have any symptoms related to throat, and neck examination showed mild swelling and tenderness. Computer tomography revealed a migrated fish bone into the lateral neck close to carotid artery, and the fish bone was removed by neck exploration under general anesthesia without any complications. Conclusion In conclusion, migrated fish bone should be suspected if patient is having persistent symptoms mainly in the neck without having difficulty swallowing and who gives a history of fish bone impaction and having negative laryngoscopic examination. Proper history taking is very important in the assessment of these patients to prevent misdiagnosis of the condition. Clinicians should aware that migrated fish bones are not uncommon and that early suspicion can prevent later diagnosis and complications.

Fishing Out a Bone From the Neck

“…Otorhinolaryngological cases of fish bone ingestion are most often encountered in countries with high rates of fish consumption, especially in coastal countries in Asia and the Mediterranean [1,3,5]. Data indicate that fish bones account for most upper aerodigestive tract foreign bodies (50%-90% of total foreign bodies) among patients living in Asian countries [3,5]. Fish bone ingestion is most prevalent in children, especially those aged two to four years, and middle-aged adults.…”

“…Fish bone ingestion is most prevalent in children, especially those aged two to four years, and middle-aged adults. In adult cases, ingestion of fish bones occurs more commonly after age 40 or older because of deterioration of the swallowing function [5]. Besides age, other factors that contribute to swallowing deterioration include pre-existing pathologies of strictures (37%), malignancy (10%), esophageal rings (10%), and achalasia (2%) [5,6].…”

“…In adult cases, ingestion of fish bones occurs more commonly after age 40 or older because of deterioration of the swallowing function [5]. Besides age, other factors that contribute to swallowing deterioration include pre-existing pathologies of strictures (37%), malignancy (10%), esophageal rings (10%), and achalasia (2%) [5,6]. However, in some cases, no pathological predisposition is present.…”

“…Fish bones are commonly found impacted at the base of the tongue or in the palatine tonsils or vallecula, where they can be easily removed in an outpatient procedure. Other sites, such as the pyriform fossa, epiglottis, and esophagus (5% combined incidence), can also be involved [2,3,5].…”

Migration of Pharyngeal Foreign Body to the Skin

“…Common sites for fishbone impaction in adults are the oropharynx /hypopharynx, oral cavity, and esophagus. 3 However, extraluminal migration FB is possible, thus causing symptoms despite negative scope findings. 4 Lateral neck radiograph is helpful to locate radiopaque FB.…”