IS Case 220: Foreign body in pharynx consistent with fish bone

Trushar Sarang, MD


Imaging Sciences URMC 2008
Publication Date: 2009-05-22

History

Patient is a 53-year-old female with a 5 day history of a foreign body sensation in her neck.

Findings

Subtle linear bony foreign body consistent with a fish bone.

Diagnosis

Foreign body in pharynx consistent with fish bone

Discussion

Radiography is commonly used to evaluate for a foreign body in the neck. Although only occasionally found the diagnosis is very satisfying when discovered.

Common radiopaque foreign bodies include coins, pins, nails, and small toys. There should be a high clinical suspicion in children, psychiatric patients, and the elderly who may have neuromotor irregularities with swallowing.

The most narrow and least distensible portion of the gastrointestinal track is the cricopharyngeal muscle, followed by the pyloris, ileocolic valve, and distal esophageal sphincter. In most cases, when a foreign body is in the stomach or below, it will eventually pass through the anus. Foreign bodies with sharp edges or lodged for more than a day are at higher risk of perforation and should be removed with an endoscope.

Endoscopy of this patient resulted in successful removal of the fish bone.

References

  1. Feied C, Smith M, Handler J, Gillam M. 6.03 Swallowed foreign body. National Center for Emergency Medicine Informatics (NCEMI). http://www.ncemi.org/cse/cse0603.htm
  2. Conners G. Pediatrics, foreign body ingestion. eMedicine, June 25, 2007. http://emedicine.medscape.com/article/801821-overview

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