Fishbone Ingestion: An Overview

Introduction:

As food is swallowed, a foreign body occasionally lodges in the upper gastrointestinal system, which frequently results in discomfort and irritation. The majority of visits to medical facilities as a result of this issue are urgent; as a result, it is crucial to know how to properly assess foreign bodies and administer treatment in an emergency medical crisis.

At any age, a foreign body in the upper gastrointestinal system can be a serious emergency. In 80–90 % of instances, the foreign body is naturally able to pass through the intestinal canal; however, in 10–20 % of cases, a minimally invasive intervention is required, and surgery is only essential in one to two percent of cases.

What Is Fish Bone Ingestion?

Accidental consumption of fish bones is known as "fishbone ingestion," and it is a frequent occurrence, particularly in regions where raw fish is considered a delicacy. When cooking or eating fish, fish bones can be sharp and easily overlooked.

Within a week, the majority of fish bones pass through the gastrointestinal (GI) tract without any issues. However, issues could arise if the fish bone becomes lodged in the GI tract. The palatine tonsil, the base of the tongue, valleculae, piriform sinus, and first thin section of the esophagus are among the locations where fish bones might become lodged.

What Is the Classification of Fish Species That Leads to Fish Bone Ingest?

A few of the recognized species of fish are as follows:

• Eel (Japanese eel, conger eel, and daggertooth pike conger).

• Flounder (right-eye flounder and left-eye flounder).

• Amberjack (Japanese amberjack and great amberjack).

What Is the Location of the Fish Bone Foreign Bodies in the Oral Cavity?

• Oral cavity and laryngopharynx:

  • Tonsil.

  • The base of the tongue.

  • Vallecullae.

  • Pyriform sinus.

• Esophagus:

  • Upper.

  • Middle.

What Is the Symptom of Fishbone Ingestion?

All of the patients described feeling prickled just after eating fish. In certain cases, additional symptoms include:

• Dysphagia (food or liquid swallowing difficulties that originate in the throat or esophagus and can range in severity from minor difficulties to a complete and painful obstruction).

• Sore throat.

• Odd throat sensations.

• Discomfort during swallowing emerged.

• Esophageal perforation.

• Deep neck abscess.

• Mediastinitis (a serious illness or inflammation of the mediastinum that could be fatal).

• Lung abscess.

• Aortic fistula (a rare but potentially deadly disorder that develops when the aorta connects abnormally to another organ or bodily part).

What Are the Risk Factors of Ingested Fish Bone?

Due to the reduction of palatal sensory feedback during swallowing, dentures are the most significant risk factor for the ingestion of foreign substances. Other risk factors include:

• Fast eating.

• Old age.

• Young age.

• Misuse of alcohol.

• Mental illness.

How Can Ingested Fish Bone Be Diagnosed?

Plain Radiograph:

• Neck Radiograph (Laterally):

• The sensitivity of direct visualizing fish bones is only about 35 % (with a range of 25-39 %).

• Depending on the fish species, the opacity of fish bones varies.

• Can be masked by fluid or swollen soft tissue

• Indirect Signs:

• Enlargement of the prevertebral soft tissues, which appears 3–12 hours after consumption.

• Esophageal gas or soft tissue.

• Radiograph of the Abdomen:

• Pneumoperitoneum and/or a minor bowel obstruction together with sharp opacity.

Computed Tomography (CT):

• More sensitive (95 %) than simple films in the identification of fish bones consumed.

• Can be covered up by oral contrast or mistaken for normal anatomy.

What Is the Treatment for Fish Bone Ingestation?

• Perforations are uncommon, occurring in less than one percent of patients, and the majority of swallowed foreign materials typically pass through the body without any problems a week after consumption. The terminal ileum, duodenum, and rectosigmoid colon are the most frequently perforated organs.

• An oral cavity or nasopharynx fish bone was removed by "direct removal" utilizing a tongue depressor and several forceps types when it was discovered.

• A rigid or flexible endoscope can be used to treat esophageal foreign bodies. The benefit of rigid endoscopes is that general anesthesia is necessary, although a range of equipment is available, and the field of view is good. However, a skilled medical professional may remove foreign bodies without general anesthesia using flexible endoscopes.

• Esophageal foreign bodies have been reported to be removed with transnasal flexible esophagoscopy (TNE). According to this article, TNE could be performed in an outpatient department (OPD) without sedation while under local anesthesia (LA).

• A non-contrast computed tomography (CT) scan is carried out when the flexible endoscopic examination fails to find the foreign body, but residue in the hypopharynx or the esophagus is still suspected.

• If a foreign body was detected by a CT scan, it was removed via “endoscopic removal” by gastroenterologists.

• Otolaryngologists remove tumors using a direct sharing oesophagoscopy under general anesthesia or through an external cervical incision in patients who have a high risk of esophageal perforation or in situations when endoscopic removal has failed. These removal methods are referred to as "surgery" in these situations.

How Can Fishbone Ingestation Be Treated at Home?

To remove the fishbone at home, try these techniques:

• Cough vigorously.

• Consume a tiny bit of vinegar to aid in the bone's breakdown.

• Sip soda.

• Consume one spoonful of olive oil to release the bone and lubricate it.

• Take a big bite out of the banana.

• Take a big bite of peanut butter and toast.

What Are the Complications of Fishbone Ingestion?

The primary side effects include:

• Laceration.

• Pharyngoesophageal wall penetration or perforation can cause infection and harm to nearby tissues.

• The risk of problems rises with the length of the fishbone (> 1 inch) and the time between ingestion and the attempted retrieval (> 24 hours).

• Laceration or ulceration of the esophagus, with or without light bleeding.

• Mediastinitis and abscess development can result from partial esophageal wall penetration.

• A tracheoesophageal fistula, recurrent pneumonia, lung abscess, empyema, and pneumothorax can all result from complete esophageal wall penetration.

How Can Fish Bone Ingestion Be Prevented?

It is possible to prevent swallowing a fish bone by accident. One way to lessen the risk is to remove the bones before cooking. However, since many bones are microscopic, it can be challenging to detect and remove them altogether.

Eating solely fish fillets is another preventative strategy. People should be aware that no technique for removing bones is flawless; therefore, there is a chance that a fish fillet still contains some bones.

Conclusion:

Fish bones are frequently swallowed, particularly by those who consume a lot of seafood. A fishbone may occasionally result in problems like abscesses, recurring infections, severe bleeding, or even stomach rupture. Ingesting fish bones frequently has no symptoms, but when they do, they may not be very distinct. Common signs and symptoms include feeling like there is something strange in the mouth or neck. Symptomatic treatment is frequently available from otolaryngologists and emergency room doctors. The gastrointestinal (GI) tract typically absorbs the ingested fishbone without any problems, usually a week or less. But occasionally, the fishbone can be affected, which could cause issues.