Endoscopic Removal of a Fish Bone Piercing in Lower Esophageal Mucosa

Abstract

Fish bones are one of the most dangerous foreign bodies to be removed endoscopically from the upper GI tract. We are reporting a rare case of endoscopic removal of fish bone which is lodged and piercing in lower esophageal mucosa. It was a 52-year-old male presented to us in the endoscopy unit of a tertiary care centre of Western Nepal. Patient was having pain in epigastric and retrosternal area from the last 4 days. Pain was aggravated with eating solid food. It started after eating dinner in a marriage party of a friend. The item included in the meal was cooked rice, green vegetables and Fish curry. Patient was treated with pain killer and antacid syrup but was of no use. So the patient came to us. After a detailed history and examination, an impacted foreign body in the esophagus was suspected. A written informed consent was taken. An emergency endoscopy was done under local lignocaine spray. During endoscopy a tip of a fish bone, which was piercing in the distal esophageal mucosa 36 cm from the incisor was noticed. Nearly 1 cm of the bone was visible in the lumen. Mucosa around the bone was erythematous and edematous. Bone was grasped with a foreign body grasping forceps and removed. After removal, it was a 4 cm fish bone. Distal 3 cm of the bone was impacted and pierced the mucosa. Patient was kept nil per oral for the next 4 days and was treated with parental fluids, antibiotics and patoprazole for next 5 days. Follow up endoscopy after 1 week has shown complete healing of penetrating site. Chest x-ray revealed a right lower lobe consolidation with minimal effusion which was treated with antibiotics and recovered. A sharp, impacted fish bone in the esophagus is an indication for urgent endoscopy. Endoscopic removal of such a bone is though challenging but is also life saving.