Salvage Technique for Endoscopic Removal of a Sharp Fish Bone Impacted in the Esophagus Using a Transparent Cap and Detachable Snares

Abstract

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. (Korean J Gastroenterol 2013;61:215-218)

Common Carotid–Esophageal Fistula following Migrated Fish Bone: A Rare Case report

“…[4][5][6][7][8][9][10] This impaction frequently occurs in oropharynx, where there are palatine tonsils, base of tongue, pyriform sinus and the vallecula. 1,5,7,[10][11][12][13][14] The other is, the esophagus (28-68% of gastro-intestinal foreign bodies were found impacted here).10 In this report it was found penetrated to cervical esophageal wall, which is the location of most, i.e. at the cricopharyngeal level, and the thoracic esophagus at the level of aortic arch.…”

“…5,3,13 In cases of the bone lead to an aorto-esophageal fistula, chest pain and hematemesis were noted. 11 In other case, pain in upper abdominal right quadrant may be observed in liver abscess secondary to migrated fish bone through the antrum of the stomach wall. 15 As in the literature, in reported boy a history of ingested fish bone, painful lump on the right lateral neck with odynophagia, dysphagia and drooling of saliva was noted.…”

“…The incidence of such a complication found is up to 35%.10 There were reports of life threatening complications such as vascular-esophageal fistula, esophageal perforation, internal carotid artery puncture, internal jugular vein thrombophlebitis, brachial plexus injury and thyroid lodgment. [1][2][3]7,10,11 However, there also reports of spontaneous extrusion of the fish bone through the skin in cervical. [3][4][5][6]14 Perforated esophagus occurs in 1-4% cases.…”

“…Formations of aorto-esophageal, subclavian anterior esophageal and carotid esophageal fistulas have been reported. 1,3,[10][11]17 Impacted fish bone for more than 24 hours is more likely to lead to major complications. The incidence of complications increases with hours.…”

“…1,2,5,10 Less frequently, particularly those where the diagnosis and management found to be delayed, fish bone may have penetrating the mucosal lining and passing through the wall, and migrated to the deep collar space, results in abscess formation. 1,3,7,10,11 There were reports of rare complications such as internal carotid artery puncture, internal jugular vein thrombophlebitis, brachial plexus injury and thyroid lodgment. [1][2][3]7,10,12 We reported a case of impacted fish bone complicated with carotidesophageal fistula and deep neck abscess treated in dr. Cipto Mangunkusumo General Hospital, that was misdiagnosed and mismanaged at the early date.…”