Horizontal impaction of fish bone in thoracic esophagus - A rare clinical entity

Abstract

Esophageal impaction of fish bone caused by accidental swallowing in adults is a challenging emergency by itself. When the fish bone is impacted horizontally at the level of thoracic esophagus it becomes not only more challenging but also a rare clinical entity. We experienced such a case in an adult male patient who had impaction of fish bone at the level of thoracic esophagus after unintentional ingestion of fish bone. The patient came to our emergency department with difficulty in swallowing and breathing especially while sitting upright associated with severe chest discomfort. A review of history revealed that he consumed a sardine 2 hours ago and since then he has been experiencing these symptoms. A plain x-ray of soft tissue neck revealed suspicion of fish bone and Computed tomography (CT) of neck confirmed an impacted linear structure with high bone density extending from the left lateral wall to right lateral wall of thoracic esophagus in close proximity to thyroid gland. Patient underwent emergency surgery with rigid esophagoscopy for extraction of fish bone under general anesthesia. This patient, had a narrow escape from lethal complications like injury of thyroid gland, pericardium and carotid artery, which are likely to happen when a fish bone is tightly stuck with both ends on esophageal mucosa which is very close to vital structures in the mediastinum. The patient was admitted for observation after the surgery, and was on antibiotics along with other symptomatic measures as a precautionary method. The patient recovered without any complications and was subsequently discharged.

Keywords

• Esophageal foreign body
• Rigid esophagoscopy