Fish Bone Impaction in Upper Digestive Tract with Life Threatening Complications: A Case Series

Abstract

Unintentional fish bone ingestion is a common perception in emergency surgery department especially in coastal areas. Authors present a case series of three patients with ingested fish bones, successfully removed from the upper digestive tract in two patients who presented immediately after ingestion. Another patient who had similar history with late presentation, had various complications and was managed conservatively. Computed Tomography (CT) scan is an important diagnostic tool in locating the foreign body and its associated complications. Contrast Enhanced Computed Tomography (CECT) carries a vital role in identifying the associated vascular injury in patients with delayed presentation with hematemesis or malena, which can be missed in plain CT. Most of the foreign bodies following ingestion pass spontaneously through the oesophagus without any complications, whereas sharp foreign body like fish bones may get stuck in the oesophagus or penetrate the oesophageal wall causing life threatening complications such as aorto-oesophageal fistula, trachea-oesophageal fistula mediastinitis, mediastinal abscess and pneumothorax. Hence, early endoscopy and intervention is the key to treatment of foreign body ingestion in upper digestive tract.

Keywords

• aorto-oesophageal fistula
• foreign body ingestion
• oesphagoscopy
• rigid oesphagoscopy
• upper gastrointestinal bleed