Computed Tomography Findings of Emergency Cases Resulting From Fish Bone Ingestion

Abstract

Fish bones are some of the most commonly ingested foreign bodies. In most cases, fish bone ingestion is asymptomatic, and the bones are expelled from the body spontaneously. Otherwise, patients with fish bone ingestion can present to the emergency department with nonspecific symptoms. Fish bones can become impacted in various part of the body. Even in cases that are initially asymptomatic after ingestion, serious complications may develop at a later stage. Computed tomography (CT) plays an important role in the diagnosis of fish bone ingestion because it is the most sensitive modality for detecting these foreign bodies. It is important to be familiar with CT findings to detect ingested fish bones and the related complications and to direct further management of the condition.

Teach a man to fillet: gastrointestinal and extra-gastrointestinal complications related to fish bone ingestion

“…Fish bones are frequently lodged in one of the three physiological sites of narrowing along the esophagus, namely the upper esophageal sphincter, eminence of the aortic arch or left main bronchus and lower esophageal sphincter, with the upper esophageal sphincter being the most commonly affected site [7]. Patients may present with foreign body sensation, pain and neck swelling [9].…”

“…The perforation commonly occurs at the lesser curvature of the stomach due to its natural angularity [10]. Patients with partial perforation of the stomach, involving partial thickness of the stomach wall, may present sub-acutely with symptoms related to peri-gastric inflammation and intra-abdominal abscess [6,9]. Non-specific symptoms such as dyspepsia can be the only presenting complaint in a patient with an embedded foreign body without perforation (Fig.…”

“…Small bowel perforation commonly occurs in the ileum and ileocecal junction, while in the large bowel, perforation commonly occurs in the rectosigmoid junction [2,9]. This is attributed to the change in bowel caliber and transition between a mobile portion of the mesocolon (ileum and sigmoid) and relatively fixed portion of the retroperitoneum (cecum and rectum) [2].…”

“…Rarely, life-threatening aorto-esophageal fistula may form [9,12]. Chiari's triad in aorto-esophageal fistula which comprises midthoracic pain, sentinel arterial hemorrhage and subsequent exsanguination, often after 24 h of sentinel bleed has been described [9,12]. A study of 2394 patients with impacted esophageal foreign bodies by Nandi et al revealed only two cases of aorto-esophageal fistula who unfortunately died as a result [13].…”

“…A study of 2394 patients with impacted esophageal foreign bodies by Nandi et al revealed only two cases of aorto-esophageal fistula who unfortunately died as a result [13]. Aorto-esophageal fistula may be treated with open surgery or combination of endovascular aortic stent graft placement followed by surgical repair [9,12].…”