Fish bone ingestion presenting to a local institution in Singapore.

Abstract

Fish bones are the most commonly ingested foreign bodies in Singapore, accounting for up to 83.9% of ingested foreign bodies.(1) The use of chopsticks to consume fish, the personal habit of deboning fish in the mouth and denture usage in the elderly have been described as risk factors for the ingestion of fish bones.(2) The first line of investigation after ingestion of fish bones would include plain radiography, but this was shown to have poor sensitivity of 23.5%–54.8%(3-5) and false negative rates of up to 40%.(6) An alternative radiological modality would be the barium study, but it is limited by its false negative rate of 40%–50%.(7) Furthermore, barium contamination can render subsequent examination and removal of the ingested fish bone more technically challenging. Therefore, the current gold standard radiological modality for diagnosis is fine-cut computed tomography (CT), which not only confirms the diagnosis and reveals associated complications but also boasts a superior sensitivity of 90.9%–100%.(4,5,8) One should, however, note the caveat that the use of oral or intravenous contrast during CT can obscure the presence of a fish bone.(8,9) Hence, for a patient with a high index of suspicion for fish bone ingestion, the ordering clinician should specifically communicate with the radiologist on the indication as well as the need for a non-contrast scan. After the diagnosis of fish bone ingestion, endoscopic removal using laryngoscopy or oesophagogastroduodenoscopy (OGD) is usually sufficient in most cases, with surgery only required in less than 1% of patients. We herein present a series of patients who ingested fish bones and presented to a local tertiary hospital in Singapore, discussing the associated complications based on the location in the gastrointestinal tract where the bones were impacted.