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CT Scan of the neck (axial & coronal views) revealed fish bone measuring 2.7 cm lying obliquely posterior to the right arytenoid cartilage with soft tissue edema.
Source publication
Ingested foreign bodies are a fairly common otorhinolaryngological emergencies encountered in Malaysia. The vast majority of these foreign bodies are fish bones which most commonly are impacted at the level of the cricopharynx. Rarely, however, a foreign body may migrate extraluminally and may even extrude subcutaneously. We report a rare occurrenc...
Context in source publication
Context 1
... no fish bone found. Due to high suspicious of the fish bone migrated extraluminally, an urgent plain CT scan of the neck was performed. It showed a fish bone measuring 2.7 cm lying obliquely posterior to the right arytenoid with surrounding soft tissue edema and highly suspicious of penetrating both common carotid artery and internal jugular vein (Fig. 2). www An emergency exploration of the neck was performed through an incision in a skin crease make on the right side of the neck. After isolating the right sternocleidomastoid muscle and retracting it laterally, the right carotid sheath was identified. The fish bone with serrated edges similar to that of stingray bone was noted to have ...
Citations
... However, some foreign bodies, such as fishbones, can move under the action of esophageal peristalsis, food swallowing, and normal pleural pressure. If not treated in time, these sharp foreign bodies may penetrate the esophageal wall, causing an esophageal perforation, and surrounding organs or main blood vessels, causing severe complications [5]. Esophageal perforation is defined as a foreign body penetrating the outer wall of the esophagus [6]. ...
Background:
Fishbone migration from the esophagus to the neck is relatively uncommon in clinical practice. Several complications secondary to esophageal perforation after ingestion of a fishbone have been described in the literature. Typically, a fishbone is detected and diagnosed by imaging examination and is usually removed by a neck incision.
Case summary:
Herein, we report a case of a 76-year-old patient with a fishbone in the neck that had migrated from the esophagus and that was in close proximity to the common carotid artery, and the patient experienced dysphagia. An endoscopically-guided neck incision was made over the insertion point in the esophagus, but the surgery failed due to having a blurred image at the insertion site during the operation. After injection of normal saline laterally to the fishbone in the neck under ultrasound guidance, the purulent fluid outflowed to the piriform recess along the sinus tract. With endoscopic guidance, the position of the fish bone was precisely located along the direction of liquid outflow, the sinus tract was separated, and the fish bone was removed. To the best of our knowledge, this is the first case report describing bedside ultrasound-guided water injection positioning combined with endoscopy in the treatment of a cervical esophageal perforation with an abscess.
Conclusion:
In conclusion, the fishbone could be located by the water injection method under the guidance of ultrasound and could be accurately located along the outflow direction of the purulent fluid of the sinus by the endoscope and was removed by incising the sinus. This method can be a nonoperative treatment option for foreign body-induced esophageal perforation.
... Another problem to keep in mind when dealing with inert foreign body is the possibility of migration within neck spaces. Therefore, in such cases, it might prove appropriate and prudent to repeat imaging on the day of surgery, rather than start surgical intervention based on the patient's older imaging films / reports [9]. ...
Penetrating neck injuries and resultant foreign bodies are quite common in otorhinolaryngology emergency and outpatient department, more so in case of road traffic / industrial work site accidents. However, these conditions require immediate medical evaluation and management as lodging of foreign bodies over a period of time may lead to altered clinical course due to complications. Residual foreign bodies in neck are quite rare. Here, we present a case of silent residual glass shards in neck in close proximity to the carotid sheath over a period of 45 days.
... In addition, Moore et al. referred the patient to vascular surgery and otolaryngology, where the fragment that migrated into the jugular foramen was removed. The authors emphasize that any foreign object that can pass through the upper digestive tract mucosa may be able to penetrate into nearby tissues, particularly the vasculature, and inflict further harm [58][59][60][61]. Another case of migration in a noble structure is presented by Casey et al.: the fractured needle migrated and penetrated the cochlea, causing hearing loss that fortunately improved after the removal of the fragment [53]. ...
Background: Dentists administer hundreds of thousands of injections every day without particular concern, but the administration of local anesthetics can cause problems. One event, fortunately uncommon, that is discussed accurately but can cause significant concern is needle breakage. The purpose of this article is to review what has been reported in the literature on this topic to learn about patient symptomatology, management and possible complications. In addition, the case of a 34-year-old patient with needle persistence in the pterygoid space due to accidental rupture during inferior alveolar nerve block (IAN) was reported, for whom non-removal and monitoring over time was chosen. Materials and Methods: A literature search of the PubMed, Scopus, Web of Science and ScienceDirect databases was conducted analyzing anesthetic needle rupture during dental surgery. Results: At the end of the selection process, 17 articles resulted. Asymptomatic subjects were found, as well as those who had several symptoms. No issues were recorded by any of the authors, whether they withdrew the needle or simply monitored the patient. Conclusions: The literature on needle rupture during dental local anesthesia is scarce, and studies report conflicting results on treatment options. Most authors reported removing the fragment; however, others preferred conservative management limited to patient monitoring. No complications were reported in any study.
... The mechanism of migration of FB through the oesophagus mucosa into neck structures is unknown. The peristaltic movement in oesophagus with neck movement can contribute to the process [21]. The strong contraction of muscles involving hypopharynx and cricoesophageal region during food propulsion make these areas to have higher chances of FB perforation, and the duration of FB retention less likely contribute to the penetration process [11]. ...
Inadvertent ingestion of foreign bodies, particularly fish bone, are a common complaint in the otolaryngology emergency practices in Southeast Asia. Due to its thin, linear, and sharp pointed end, fish bone has the potential to penetrate through the oesophagus wall, or migrate extraluminally towards the surrounding structures in the neck, resulting in bizarre and lethal complications. We present an unusual case of extraluminal migration of foreign body (FB) and 2 cases of completely embedded FB in the oesophagus wall. We aim to share our experience in both conservative approach and transcervical approach for these difficult clinical problems. All of them have minimal rigid oesophagoscopy findings but possess the radiological evidence of FB. Computed tomography scan have higher sensitivity and provide good preoperative guidance, it should be done early and performed in the event of negative endoscopic evaluation. Prompt diagnosis and early retrieval of FB can significantly reduce morbidity and mortality.
... Penetration of migrated fish bone through the major blood vessels in the neck may lead to fatal complications such as aorto-oesophageal fistula or carotid rupture. However, it has been reported that fish bone that pierced through the common carotid artery and internal jugular vein can be removed safely without causing massive bleeding [10,11]. ...
Introduction
Incidental fish bone ingestion may penetrate the upper aerodigestive tract and cause extraluminal migration due to late presentation or missed diagnosis. The migrated fish bone exhibits a wide spectrum of clinical manifestations, ranging from mild symptoms to potentially fatal complications.
Presentation of case
We report three cases of extraluminal fish bone migration with diverse clinical presentations and complications. The first patient had mild throat symptoms and a fish bone that travelled through the neck and migrated towards the subcutaneous tissue without causing complications. The second patient developed deep neck abscess and thoracic complications as a result of the migrated foreign body, but recovered after surgical exploration and foreign body removal. The third patient presented late in sepsis and upper airway obstruction, subsequently succumbed to multiorgan failure before any surgical intervention.
Discussion
Thorough physical and endoscopy examinations are essential in patients with fish bone ingestion. Normal endoscopic findings in a symptomatic patient should always raise the suspicion of a migrated fish bone. A radiographic imaging study is often helpful in locating the foreign body and potential complications. The migrated fish bone that acts as the source of infection in the neck should be traced and removed surgically. The resulting abscess, if present, must be drained. The management of a migrated fish bone can be challenging and often require multi-discipline collaboration.
Conclusion
The migration of the ingested fish bone outside the upper aerodigestive tract can cause serious complications and death in some cases. Clinicians should always maintain a high level of suspicion towards extraluminal migration in a patient with a history of fish bone ingestions but normal endoscopic findings. We emphasize the importance of early recognition and prompt surgical intervention to remove the migrated fish bone to minimise the potential morbidity and mortality.
... 5,6 It is postulated that combination of oesophageal peristalsis and neck movement is the reason behind migration. 7 Migration is assumed to have occurred when the foreign body or any type of complication related to foreign body is documented radiographically with negative endoscopy. 8 Migratory foreign body can remain silent, extrude through the skin or cause serious complications. ...
Introduction
The most common complication following accidental ingestion of a foreign body is entrapment in the upper digestive tract. Spontaneous penetration of a foreign body through the upper digestive tract and migration into the soft tissues of the neck is very uncommon. Consequences from such migratory foreign body can be serious and potentially fatal.
Case Report
Thirty six years old female presented with history of accidental ingestion of an unknown foreign body 3 days back. Clinical examination, plain radiography, hypopharyngoscopy and oesophagoscopy failed to find out the foreign body. Thereafter the patient developed thyroid abscess which was confirmed by computed tomography. Surprisingly we discovered the foreign body during surgical exploration of neck.
Conclusion
In a case of accidental ingestion of foreign body, even if initial evaluation with endoscopy and plain radiography are negative, the patient should be followed closely until resolution of symptoms. A high index of suspicion of migration of foreign body should be maintained. Retrieval of migratory foreign body needs surgical expertise and experience.
... In our investigation, 109 patients (45.4%) required endoscopic or surgical removal, but none of the patients needed neck exploration surgery. Tang et al. have described neck exploration surgery for a migrating foreign body as "fishing for a needle in the deep ocean" [27], suggesting that this kind of surgery must be challenging. Thus, it is important to perform adequate preoperative assessment and effective imaging examinations during the operation, such as ultrasonography [18]. ...
Background
Fish bones are common foreign bodies in the upper aero-digestive tract, but their clinical features in relation to fish species have not been confirmed. We aimed to clarify the clinical characteristics of fish-bone foreign bodies and their location and removal methods depending on the fish species.
Study design
Retrospective, observational, monocentric study.
Methods
From October 2015 to May 2020, 368 patients visited the Department of Otolaryngology-Head and Neck Surgery at Tohoku University Hospital complaining of dysphagia, sore throat, or pharyngeal discomfort after eating fish. We analyzed the patients’ sex and age distribution, foreign-body location, type of the fish, and the techniques used for removing the foreign body.
Results
Fish bones were confirmed in the upper aero-digestive tract in 270 cases (73.4%), of which 236 (87.4%) involved fish-bone foreign bodies in the mesopharynx. The most frequently involved site was the palatine tonsil (n = 170). Eel was the most frequently observed fish species (n = 39), followed by mackerel (n = 33), salmon (n = 33), horse mackerel (n = 30), and flounder (n = 30). Among the 240 cases in which the bones did not spontaneously dislocate, 109 (45.4%) were treated by endoscopic removal (103 cases) or surgery (6 cases). In pediatric cases (<12 years old), almost all fish bones were found in the mesopharynx (138/139, 99.3%), and 31 cases (22.3%) required endoscopic removal. Flounder fish bones were often lodged in the hypopharynx and esophagus (9/30, 30%), hindering spontaneous dislocation and frequently necessitating endoscopic or surgical removal (19/29, 65.5%).
Conclusion
The characteristics of fish-bone foreign bodies differed depending on the fish species. Flounder bones were often stuck in the hypopharynx and esophagus and were likely to require more invasive removal methods. Confirming the species of the fish could facilitate appropriate diagnosis and treatment of fish-bone foreign bodies.
... Az idegen testek tünetszegény módon juthatnak el a kiindulási pontoktól viszonylag távoli helyekre. A nyak régiójában a carotishüvely, a pajzsmirigyállomány, az arteria carotis communis és a vena jugularis együttes laesióját okozó helyzetből, de a nyak bőre alól, a szubkután régióból is távolítottak el lenyelt és elvándorolt idegen testet [8,11,12]. A gyomorból távozó, a májban abscessust okozó lenyelt idegen testről szóló első közlés Lamberttől származik, 1898-ból [13]. ...
Migration of swallowed foreign bodies from the gastrointestinal tract is a rare phenomenon compared with the total number of ingestions. In the reported two cases, the serious septic condition indicated urgent surgical intervention. We found a piece of wire swallowed a few months earlier in the right lobe of the liver and the retroperitoneum in case one, and a piece of wire in the pericardium, which migrated from the stomach through the left lobe of the liver, in case two. Abscesses and phlegmonae were found in the retroperitoneum and then in the femoral region requiring a reoperation in case one, and in the liver and pericardium in case two. After the evacuation of abscesses, both patients made full recovery. Diagnostic difficulties and therapeutic challenges served the reasons to present these cases. Orv Hetil. 2019; 160(42): 1677–1681.
... All of which can lead to penetration of the major blood vessels causing fistulas, sepsis, blood vessel rupture, and death. 6 A thorough endoscopy and computed tomography (CT) scan of the neck with and without oral contrast are the gold standard for diagnosis. 7 Pre-operative imaging is tantamount in locating a foreign body that has migrated. ...
Meticulous history taking and careful examination should always be performed in all patients because a common symptom, such as sore throat, could be a presentation of an unusual problem. Sore throat from an ingested foreign body can perforate the mucosa and migrate extraluminally penetrating vital structures of the neck. Rare documentation of such cases involves sharp objects and, if untreated, may result in life-threatening complications. This article presents a case of a patient with a 3-week history of sore throat, and diagnostic work-up revealed a sharp metallic foreign body (needle pin) in the hypopharynx, which migrated extraluminally through the posterior pharyngeal wall. There were no signs or lesions on endoscopy to help point the exact entry point and location of the foreign body. Intraoperative imaging using C-arm was used to identify the exact position of the foreign body, which was at the level of C4, 0.5 cm deep to the right lateral posterior pharyngeal wall mucosa, and oriented lateral to the vertebra. The needle pin was subsequently extracted.
... Unusual carotid foreign bodies have been described in multiple case reports ranging from firearm fragments and fish bones secondary to penetrating injuries to iatrogenic migration of wires, catheters, and balloons used during endovascular procedures. [4,7] Most foreign bodies migrate into the distal internal carotid artery or proximal middle cerebral artery due to its size relative to the parent vessel. The optimal management of internal carotid artery foreign bodies is unknown due to its rarity and lack of high level literature. ...
Background
Neuroendovascular techniques have significantly altered the treatment paradigm of cerebrovascular diseases. Since the introduction of distal cerebral protection devices (DCPD), the incidence of embolic strokes during carotid artery stenting (CAS) has been significantly reduced. Treatment guidelines for retained foreign bodies in the cerebral vasculature do not exist.
Case Description
Here, we present the case of an 88-year-old male who, during carotid artery angioplasty and stenting for symptomatic carotid artery stenosis, suffered from a retained distal protection device ultimately requiring open surgical carotid endarterectomy including removal of the retained device and stent.
Conclusions
Carotid artery angioplasty and stenting utilizing distal protection devices is a commonly employed technique that may rarely result in retained devices. Knowledge of how to retrieve foreign bodies and the salvage techniques are essential to prevent complications from CAS.
