Interesting Case Studies

Swallowed Fishbone Accidentally

History:
An elderly grandmother celebrated her birthday with her family by having fish-head curry for dinner.
Halfway through her meal, she accidentally swallowed a fishbone and felt choked in her throat.
Her children offered her rice to swallow with the intention of pushing the bone down. Upon doing that, she felt the pain move down towards the upper part of her chest and even had difficulty drinking water.
Her family immediately brought her to the hospital emergency unit and she was referred to an ENT specialist for assessment.

What we did:
During the initial assessment, an oral examination and in-office endoscopy did not reveal any fishbone. However, X-ray done in the emergency unit revealed a suspicious foreign body in the deeper part of her throat.
That same evening, she had to undergo an emergency operation, under general anaesthesia.

During the operation, a rigid scope was introduced into her food passage (oesophagus) and the fishbone was successfully identified.
A pair of grasping forceps was used to dis-impact the bone and the bone was successfully removed.

Fig 5a. A rigid scope introduced into her food passage (oesophagus).

Fig 5b. Fishbone removed.

Diagnosis:
Foreign Body in Throat

Discussion:
Accidental ingestion of fishbone is one of the common ENT emergencies in Singapore.

NEVER attempt to dislodge it by swallowing large food bolus such as cooked rice or drink vinegar (with the hope to digest the bone). All these methods DO NOT WORK.

In fact, it worsens matters frequently by pushing the bone deeper into the food passage. When this happens, the only solution would be removing the bone under anaesthesia as in our case study.

Thankfully most ingested bones can be easily removed if they were stuck in the upper parts of the throat (usually tonsils or even the base of the tongue). These are removed using direct forceps or a therapeutic scope, which can be performed in the office/outpatient.
Remember, whenever you suspect you have accidentally swallowed a fishbone, do the right thing by not doing anything… head straight to your nearest doctor for assistance.

 

Contributed by: Dr Eng Soh Ping Elliot