Common Carotid–Esophageal Fistula following Migrated Fish Bone: A Rare Case report

Abstract

Introduction . Accidental ingested fish bone is a quite common clinical problem in emergency department, especially in Asian countries where un–filleted fish is a delicacy. Normally, the fish bone will be passing by through GI tract. Less frequently it may have penetrated to esophagus lead to a serious complication should it penetrated to surrounding collar structures and get infected. We report a case with a serious complication. Case Report. A fourteen year–old mentally retarded boy came with a painful lump on his neck for 6 days before admission with history swallowing a fish bone 7 day before. An exploratory surgery was set for him. Intra operatively, fish bone found to have penetrated the esophageal wall and passed through the common carotid artery and internal jugular vein with a carotid–internal jugular vein–esophageal fistula. The carotid artery and internal jugular vein were resected; the esophageal fistula was then left open for a conservative treatment. He was discharged on day 56. Conclusion. The penetrated esophagus referred to the port d’ entree of deep collar compartment infection. Furthermore, fish bone penetrated further to adjacent structures. Such complication is fatal, Early diagnosis and prompt treatment should be carried out. Keywords : Vascular–esophageal fistula, carotid–jugular–esophageal fistula, migrated fish bone, deep collar abscess, esophageal perforation