Computed Tomography Diagnosis of Esophageal Bone Impaction: A Prospective Study

Eliashar, Ron; Dano, Itzhak; Dangoor, Eric; Braverman, Itzhak; Sichel, Jean‐Yves

doi:10.1177/000348949910800717

Cited by 94 publications

(63 citation statements)

References 8 publications

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“…To date, several studies have been published on the usefulness of CT (Eliashar et al 1999;Lue et al 2000) for cases in which an impacted fish bone in the pharynx-esophagus is suspected. In our patient, we identified the foreign object by using intraoperative ultrasonography, as well as preoperative assessment, avoiding the risk of accidental bleeding or tissue damage that may be caused by blind exploration.…”

Section: Discussionmentioning

confidence: 99%

The Prolonged Presence of a Fish Bone in the Neck

Watanabe

Amano

Nakanome

et al. 2012

Tohoku J. Exp. Med.

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Fish bones are one of the most frequently observed ingested foreign bodies in the pharynx-esophagus. Fish bones have a tendency to stick and penetrate the mucosa, which can occasionally lead to severe or lethal complications. The extraluminal migration of fish bones in the upper digestive tract is a rare event, and it is even more unlikely that the foreign body will remain in the neck for a prolonged period. We report the unique case of a 69-year-old woman who remained asymptomatic, while a fish bone was lodged in her neck for 9 months. Finally, after her anterior neck had become swollen, she underwent neck exploration, which revealed that the fish bone was embedded in the scar tissue running from within the thyroid gland to outside of the thyroid. Treatment proceeded without complications, and the foreign body was removed successfully. The length of the fish bone was 34 mm. Intraoperative ultrasonography was able to identify the fish bone in situ using real-time imaging; therefore, we recommend this technique for locating migrated foreign bodies in the neck. Ingested fish bones are one of the most frequently observed foreign bodies in the pharynx-esophagus (Remsen et al. 1983;Loh et al. 2000;Athanassiadi et al. 2002); particularly in East Asia, a whole fish is often served without removing its bones. Owing to their fine, linear, and sharp structure, fish bones have a tendency to stick and penetrate the mucosa, which can occasionally lead to severe or lethal complications. The extraluminal migration of fish bones in the upper digestive tract has been reported only rarely, and it is even more unlikely that the foreign body will remain in the neck for a prolonged period. In addition, although neck exploration for migrated foreign bodies is a difficult procedure, there are a few studies used intraoperative ultrasonography in the head and neck region (Ng et al. 2003;Masuda et al. 2006). We report the rare case of a migratory fish bone that remained asymptomatic in the neck for 9 months before its removal, and include a review of the related literature. Clinical ReportA 69-year old woman was referred to our institution with an enlarged anterior neck. Local neck symptoms had worsened compared with those a few days before presentation. A computed tomography (CT) scan revealed a softtissue shadow of increased density, and a fine linear radiopaque object was found located in the right neck region. The patient remembered that a fish rib bone had stuck in her throat while she was eating a grilled fish (a horse mackerel) 9 months ago, although she had been asymptomatic until the present time.Physical examination revealed skin flare and swelling on the anterior neck across a region that was approximately 60 mm in diameter, and the center part of the involved area had an eroded surface with easy bleeding. No fever was present and the patient did not report tenderness in the affected region. No abnormal findings were found in any other region of the head and neck. A blood examination revealed slightly increased levels of white...

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Section: Discussionmentioning

confidence: 99%

The Prolonged Presence of a Fish Bone in the Neck

Watanabe

Amano

Nakanome

et al. 2012

Tohoku J. Exp. Med.

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“…Gastrograffin may be helpful in localizing a suspected perforation but causes severe pneumonitis if aspirated due to its hypertonicity. CT can occasionally detect objects that are missed by other modalities [32,33] and is useful in detecting complications [34,35]. It is imperative to remember that failure to demonstrate a foreign body radiographically does not preclude its presence.…”

Section: Diagnostic Evaluationmentioning

confidence: 99%

Esophageal foreign bodies: Types and techniques for removal

Smith

Wong²

2006

Curr Treat Options Gastro

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Patients with esophageal foreign bodies require prompt diagnosis and therapy. The first tasks are to determine the type of object, time since ingestion, location of the object, and the likelihood of associated complications. Patients who have evidence of complete esophageal occlusion or who have ingested a sharp or pointed object require urgent treatment due to the increased risk of complications. Button batteries are particularly injurious in the esophagus and should be removed immediately. Coins in the esophagus should also be removed; however, a brief period of observation is appropriate for coins in the distal esophagus, as some will pass spontaneously. Flexible endoscopy is the therapeutic modality of choice for most patients. The key principles for endoscopic management of esophageal foreign bodies are to protect the airway, to maintain control of the object during extraction, and to avoid causing additional damage. Endotracheal intubation is sometimes necessary, especially in younger children and those at higher risk for aspiration. The use of devices such as an esophageal overtube and a latex protector hood may facilitate safer extraction of sharp/pointed objects. Patients with food impactions usually require treatment of an associated structural lesion of the esophagus.

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“…The percentage of false positive results in this study was 22%. (7,8,9) Studies have found that plain film is false negative in 30 to 55% of cases and false positive in 24% cases. 5(8%) cases showed indirect evidence of foreign bodies in digital X-ray in this study.…”

Section: Discussionmentioning

confidence: 99%

A Clinical Study of Foreign Bodies of Oesophagus and Their Management

P¹,

Sabin²,

S³

2015

jebmh

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INTRODUCTION:A foreign body is an endogenous or exogenous substance incongruous with the anatomy of the site where it is found. Foreign body ingestion can affect persons of any age. Despite major advances in diagnostic and therapeutic modalities, foreign body ingestion still causes significant dilemmas in the diagnosis and treatment. Multiple factors play role in the lodgment of these foreign bodies in the food passage. They are diet factor, dental factor, and inebriation and age factors to name a few. Preexisting strictures of esophagus is another local cause of impaction of F.B. The signs and symptoms of foreign body ingestion are quite diverse and often very non-specific. They include complete esophageal obstruction with overflow of secretions and aspiration, to mild odynophagia or dysphagia. Esophageal foreign bodies are most frequently located at the narrowest portion of the esophagus, the level of the crico-Pharynx sphincter. Rarely serious complications of such as mediastinitis, Pneumothorax, plural effusion, lung or mediastinal abscess, or massive hemorrhage due to a vascular fistula may occur before a thorough investigation is launched. Digital X-rays in two dimensions are useful in the diagnosis. CT scanning and MRI are rarely used in the evaluation of foreign bodies in the aero digestive tract, but are indicated in the event that the object is not found during endoscopic examination and migration from the airway or esophagus is suspected. In 1936 Chevalier Jackson described endoscopic techniques for the removal of foreign bodies. Since then this has remained the safest and most trusted method of treatment. Techniques for foreign body removal employing fiber optic endoscopes have been described. The treatment of choice for foreign bodies of the upper aero digestive tract is reasonably prompt endoscopic retrieval in the operating suite under anesthesia. Endoscopy is performed as an emergency in case ingestion of disc batteries with esophageal lodging and signs or symptoms of esophageal perforation to avoid further complications and strictures. AIM: To evaluate the sensitivity and specificity of digital Xray in detecting all foreign bodies impacted in throat and esophagus. To assess the factors leading to false positive findings in Digital X-rays in the study subjects; to evaluate the role of digital X-ray in detecting complications. MATERIALS AND MEHODS: 208 patients attending Government Hospital of Kozhikode with history of foreign body ingestion are included in the study. Thorough history taking, clinical examination followed by radiography with the help of Digital X-rays to locate the foreign body is done. Fish bones being common in this part of Kerala, emphasize is made to find the specificity and sensitivity of using digital X-rays in locating fish bones in food passage. Conservative management in patients showing minimal symptoms is studied. The incidence of Complications among the patients is studied. OBSERVATIONS: The sensitivity of digital X-ray in detecting fish bone foreign bodies i...

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Computed Tomography Diagnosis of Esophageal Bone Impaction: A Prospective Study

Cited by 94 publications

References 8 publications

The Prolonged Presence of a Fish Bone in the Neck

The Prolonged Presence of a Fish Bone in the Neck

Esophageal foreign bodies: Types and techniques for removal

A Clinical Study of Foreign Bodies of Oesophagus and Their Management

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