Thyroid lobectomy for removal of a fish bone

Abstract

A 42-year-old female Jordanian patient presented with a history of sudden painful dysphagia following swallowing of a fish bone. Though soft tissue X-rays showed a foreign body in the neck, repeated oesophagoscopies failed to reveal it. Computed axial tomography was done and showed a fish bone embedded in the left thyroid lobe. Left thyroid lobectomy was carried out and the fish bone was seen within the lobe surrounded by an area of acute inflammation.

Foreign Body Perforation of the Cervical Esophagus

“…Perforation of the esophagus by a fish bone with lodgment of the fish bone in the thyroid is extremely rare and seems to have been reported only once in the literature. Coincidentally, that case was reported from Kuwait [3], In the four cases of penetrating foreign body of the upper aero-digestive tract reported by Rem sen et al [2], the thyroid formed part of an inflammatory mass in one case, but the for eign body was in the paraesophageal space, not in the thyroid.…”

“…The longer a foreign body is retained, the more likely it is to cause perforation of the esophagus. Only a small number of foreign bodies perforate the esophagus and an even smaller number mi grate extraluminally [3], In a series of 2,394 patients who have swallowed foreign bodies, only 25 were penetrating and only 1 was extraluminal [4], Remsen et al [2] in their review of the world literature listed 321 cases of penetrating foreign bodies reported be tween 1818 and 1983. Of the 249 cases in which gender was indicated, there were 132 males and 117 females.…”

Migrating Extraluminal Foreign Body Hypopharynx

“…They may cause suppurative complications such as deep neck abscesses, mediastinitis [4] or vascular complications due to penetration of carotid artery, its branches and the internal jugular vein [5]. A case of thyroid gland penetration by a migrating foreign body with subsequent abscess of thyroid lobe has been reported for which thyroid lobectomy was done [6]. Evaluation of these cases with radiograph neck can show the presence of a foreign body if it is radioopaque.…”

Extraluminal hypopharyngeal foreign body

“…An even smaller fraction of cases occur in which the foreign body penetrates the wall and "migrates" through the deeper layers. In some instances, the foreign body can migrate completely through the wall and become lodged in the soft tissues of the neck [1,2]. There have been cases reported in which the foreign body actually exits through a puncture wound in the skin of the neck [3].…”