Thoracic spinal epidural abscess caused by fishbone perforation

Abstract

Rationale:Ingestion of a fishbone is a common cause of esophageal injury, but spinal epidural abscess (SEA) is a rare condition due to the esophageal penetration by a swallowed fishbone. Prompt diagnosis can be seldom made owing to incomplete patient history taking and difficulties in imaging evidence identification.Patient concerns:We describe the case of a 62-year-old woman who was stuck in her throat by a fishbone, and complained of back pain, paresis of the lower limbs and fever, successively. To our knowledge, this is the first case report that we know of thoracic SEA caused by fishbone perforation.Diagnoses:About 20 days after the onset of severe back pain, she was diagnosed with SEA based on the clinical presentation and imaging findings.Interventions:Antibiotic therapy and rehabilitation therapy were carried out afterwards. However, due to exacerbation of her condition, surgical intervention had to be taken eventually.Outcomes:It is quite unfortunate for this patient to have a poor prognosis due to a delayed diagnosis and an improper management.Lessons:A number of lessons can be learnt from this case.

Unusual Foreign Bodies of Surgical Discovery on a Traumatic Spine

“…Sometimes the foreign body can be accidentally discovered during a routine radiological examination [9]. The circumstances of discovery are often the appearance of a persistent infectious syndrome [10] preceded by persistent pain [1] [7]. This persistent characteristic pain described in the literature [3] [11] seemed more related to spinal trauma in our case.…”

“…The incidence of foreign bodies ranges from 1/1000 to 1/10,000, of which 80% are textiloma [1] [4] [5]. Foreign bodies were frequently connected to abdominal In reaction to fibrous aseptic tissue, the formation of a fibrous capsule would lead to granuloma [1] [5] [7]. In this case, the patient may remain asymptomatic for days to years [4] [8].…”

“…Piece of plastic appearing after a posterior approach (A and B1), a piece of fabric (B2) and finally a gauze (B3). or thoracic surgery[5] [6][7] rarely after surgery on the spine [2][3]. Most para-spinal foreign bodies are poorly documented[8].…”

“…They probably would have migrated and continued their course to the thoracic spine through the posterior hole caused by the trauma.The dorsal para-spinal migration described in this article could be evoked as a mechanism, although exceptional. Gauze used is generally useful to stop hemorrhage[6] [7]. Although precautions are taken to avoid leaving such materials, errors occur.…”

“…This image made it possible to suspect the presence of a foreign body. The introduction of MRI, which seems more efficient, has made it possible to diagnose most foreign bodies[7] [13]. It allows an excellent visualization of the characteristic internal structure of the foreign body in three planes of space.…”