Esophageal Fish Bone Research Articles

Vascular covered stent and video-assisted thoracoscopic surgery for Aortoesophageal fistula caused by esophageal fishbone: a case report

BackgroundAortoesophageal fistula (AEF) is a rare condition characterized by communication between the aorta and esophagus. AEF caused by an esophageal foreign body is even rare, and there is currently no recommended standard treatment protocol. We report a case of delayed aortic rupture after the endoscopic removal of a fish bone, which was successfully treated with a combined approach of vascular stenting and thoracic surgery.Case presentationA 33-year-old man presented to the hospital after experiencing chest discomfort for 3 days following the accidental ingestion of a fish bone. Under endoscopic guidance, the fish bone was successfully removed, and the patient was subsequently admitted for medical therapy. On the fourth postoperative day, the patient suddenly developed hematemesis, and chest computed tomography angiography revealed the presence of an AEF. This necessitated urgent intervention; hence, thoracic surgery was performed and a vascular-covered stent was placed. Following the surgical procedure, the patient received active medical treatment, recovered well, and was successfully discharged from the hospital.ConclusionsIn patients with esophageal perforation caused by foreign bodies, hospitalization for observation, computed tomography angiography examination, early use of antibiotics, and careful assessment of aortic damage are advised. Thoracic endovascular aortic repair and esophageal rupture repair may have benefits for the treatment of AEF.

Esophageal fish bone impaction: the importance of early diagnosis and treatment to avoid severe complications.

Esophageal fish bone impaction (EFBI) is a common reason for presentation in the emergency department and a frequent indication for urgent esophagogastroduodenoscopy (EGD). Although it is usually effectively diagnosed and treated by EGD, a confirmed diagnosis prior to the endoscopy is rare as blood tests, radiography and direct laryngoscopy are usually normal. We herein report three cases of EFBI. Two patients had been previously discharged without a correct diagnosis. In one case, the patient had a severe complication that required urgent surgery which could have probably been averted with an early diagnosis. Remarkably, a cervical CT scan was key to diagnose the EFBI in one case and a large retroesophageal abscess in another cases, thus guiding their management. Both patients that underwent an urgent EGD had a favorable outcome without the need for hospitalization. Therefore, meticulous anamnesis, adequate imaging and urgent EGD are key to treat patients with EFBI.

Proposal for methods of diagnosis of fish bone foreign body in the Esophagus.

To investigate the methods of diagnosis of fish bone foreign body in the esophagus and suggest a diagnostic protocol. Prospective cohort study. A prospective study was performed on 286 patients with a history of fish bone foreign body impaction. Among them, 88 patients had negative findings in the oral cavity and laryngopharynx. Subsequent radiologic assessment of these patients included plain radiography and computed tomography (CT). Sixty-six patients showed positive findings in the esophagus, and an attempt was made to remove the obstruction using transnasal esophagoscopy. In 66 patients, a fish bone foreign body was detected in the esophagus by CT. In contrast, plain radiography detected a foreign body in only 30 patients. The overall detection rate of plain radiography compared with CT for fish bones was 45.5%. Plain radiography detected 35.9% of the simple type fish bones and 54.5% of the gill bone detected by CT. However, jaw bones had a detection rate of 100% with both methods. The fish bone foreign bodies were most commonly located in the upper esophagus (n=65, 98.5%), followed by the lower esophagus (n=1, 1.5%). CT is a useful method for identification of esophageal fish bone foreign bodies. Therefore, CT should be considered as the first-choice technique for the diagnosis of esophageal fish bone foreign body. 4.

Analysis of Clinical Feature and Management of Fish Bone Ingestion of Upper Gastrointestinal Tract.

ObjectivesFish bone impaction in the upper gastrointestinal tract is a common reason for patients to seek emergent care. The aim of this study was to find a clinical characteristics of patients with fish bone impaction in the upper gastrointestinal tract.MethodsThe study was conducted on 286 fish bone ingestion patients who complained of dysphagia and irritation after eating fish. The patients were treated according to the hospital protocol regarding the removal of fish bone. The parameters for the analysis included the age and sex of the patients, location and characteristics of the foreign body, method of removal, and type of fish.ResultsThe fish bone could be observed by the physical examination in the oral cavity and laryngopharynx in 198 patients (69.23%). For those patients in whom the foreign body could not be observed in oral cavity and laryngopharynx, noncontrast computed tomography (CT) (from nasopharynx to diaphragm) was performed. The fish bone was discovered in the esophagus of 66 patients (23.08%). The esophageal fish bone was successfully removed by transnasal flexible esophagoscopy (TNE) in 55 patients, the fish bone moved to the stomach in 10 patients and one fish bone was removed by rigid esophagoscopy due to esophageal abscess. The esophageal fish bone was mostly found in patients aged 50 years and older.ConclusionFish bone foreign body ingestion in the esophagus appeared to be more common in older patients. Incorporating noncontrast CT and TNE can facilitate decision-making and adequate treatment for patients with fish bone impactions.

Fish bone foreign bodies in the pharynx and upper esophagus: evaluation with 64-slice MDCT

Fish bone (FB) is one of the common causes of foreign body impaction in the pharynx and esophagus. To investigate the efficacy of 64-slice multidetector computed tomography (MDCT) for the evaluation of pharynx and upper esophageal FB foreign bodies. Sixty-six patients with suspected FB foreign body ingestion were examined by plain radiography (n = 40) and unenhanced MDCT (n = 66). We analyzed the presence, location, size, shape, and lying position of the foreign bodies. On MDCT, 46 foreign bodies were detected. Among them, 45 were confirmed by endoscopy. The sensitivity of MDCT for the detection of foreign bodies was 100%, which was superior to that of the plain radiography (51.7%). The location of the foreign bodies was most common in the upper esophagus (n = 22, 47.8%), followed by pharyngoesophageal junction (n = 10, 21.7%), transjunctional (n = 7, 15.2%), hypopharynx (n = 5, 10.9%), and oropharynx (n = 2, 4.3%). Their longest length was 5.3-40.1 mm (mean, 21.3 mm). Thirty-three FBs (71.7%) were linear and 13 (28.3%) were flat in shape. They showed transverse (n = 23, 50.0%), parallel (n = 13, 28.3%), and oblique positions (n = 10, 21.7%) to the long axis of the pharynx and esophagus, respectively. MDCT is useful for the evaluation of the pharynx and upper esophageal FB foreign bodies.

A submucosal esophageal fish bone foreign body surgically removed using intraoperative ultrasonography

A 68year-old female was referred to our department with a history of swallowing a fish bone, she reported continuous pain when swallowing. The bone was not evident on endoscopic examination; however, on CT scans a foreign body was identified in the upper esophagus. The bone was buried in the mucosa of the upper esophagus and an emergent rigid esophagoscopy was performed under general anesthesia in order to remove it. The fish bone was successfully removed with the use of intraoperative cervical ultrasonography.

Esophageal fish bone migration induced thyroid abscess: case report and review of the literature

A thyroid abscess is a rare condition, and it is so infrequently encountered. A migrated fish bone is a rare otolaryngologic emergency indicated when the foreign body penetrates through the esophageal mucosa into the thyroid gland space of the neck after several weeks of swallowing. We present the case of a 50-year-old woman who had fever and anterior neck painful mass. An intrathyroid abscess was diagnosed; and she underwent thyrotomy with transcervical approach. A foreign body, which proved to be a fish bone and which fortunately did not cause any adverse effects, was removed.

Clinical Analysis of Esophageal Foreign Body in Jeju

Purpose: The esophageal foreign body results from ingestion of various materials and some foreign bodies such as fish bone can make severe complications such as esophageal perforation and acute mediastinitis. The purposes of this study were to investigate the clinical characterisitcs of esophageal foreign body in Jeju and to analyze the complicated cases by esophageal foreign body.Methods: A total 32 patients who were treated for foreign body in gastrointestinal tract at Cheju National University Hospital from May 2003 to October 2006 were reviewed retrospectively. The review about clinical informations included patient's age, sex, chief complains, presentation time from symptom, duration of admission, endoscopic treatment, and complications. The length and type of foreign body also were reviewed. Complicated group and non-complicated group were compared in aspect of probability of complications in esophageal foreign body.Results: Male was 65.6% and pediatric under 15 years old was 40.6%. The mean age was 35.53±25.98 years old and the mean presentation time from symptom was 27.98±53.95 hours. Dysphagia and foreign body sense was major chief complain in adults and most pediatric had no symptom. Most foreign body were located in esophagus and the mean size of foreign body was 2.34±1.06 cm. The most common foreign body was fish bone and 35.7% among fish bone injuries had complication such as esophageal perforation and acute mediastinitis. Compared with non-complicated group, complicated group was older and had longer presentation time from symptom and more chest pain as chief complains significantly.Conclusion: The most esophageal foreign body in Jeju was fish bone, that made more complications than the other areas. Older patient with esophageal fish bone who presented later and had chest pain could be supposed to have complications by fish bone.

内視鏡処置後に気腫を生じた食道魚骨異物の１例

A 70-year-old woman was admitted to our hospital because of a cervical esophageal perforation caused by a flexible fiberscope. After an esophageal fish-bone foreign body was removed by a flexible fiberscope, the patient's cheek, neck and anterior chest wall started swelling. Chest X-ray and computed tomography revealed mediastinal and subcutaneous emphysema. Dyspnea was not observed, oral intake was withheld, and antibiotics were administered. Surgery was not attempted, since no symptoms were observed within 72 hours after the injury. Four days after admission, a fluoroscopic X-ray examination of the neck, thorax and esophagus was performed. Oral intake was restarted on the fifth day, and the patient was discharged on the tenth day.

Computed tomography diagnosis of esophageal bone impaction: a prospective study.

A prospective study was performed on 45 patients for an assessment of the use of computed tomography (CT) in the management of a suspected esophageal fish bone or chicken bone. All patients had negative findings on laryngoscopy; therefore, pharyngeal and hypopharyngeal foreign bodies were excluded from further consideration. The patients underwent radiographic examination with plain films and a cervical CT scan without contrast material. Patients with positive findings were taken to the operating room, where they underwent rigid esophagoscopy under general anesthesia, while those with negative findings remained for observation for 24 hours. Thirty CT scans were positive for an esophageal foreign body, and in all cases but 1, a foreign body was found during the operation. Fourteen of 15 patients with normal CT scan findings managed well with no further intervention. One patient with persistent complaints underwent esophagoscopy, but no foreign body was found. Our conclusion is therefore that CT is a simple and reliable method for diagnosing esophageal bone impaction and may reduce the rate of unnecessary esophagoscopies.

気道・食道異物 医外史

Broncho-esophageal foreign bodies have been seen throughout human history. This paper presents foreign body cases from Japanese ancient writings particularly after 10th AD. and the correct location of trachea and esophagus, and future problems for foreign body treatments.1) There were several interesting removal methods. For example, a laryngeal rice-cake foreign body was removed by drinking vinegar, and an esophageal fish bone was removed with a hemp stick, and a pin using an array of beads with a string in the esophagus.2) T. Yamawaki pointed out the correct position of the trachea and esophagus in his book titled“Zohshi” (1759). Before this book, people had thought that the position of the esophagus was in front of the trachea.3) Two hundred modern Japanese people were asked where the location of trachea and esophagus were. Thirty-two percent of them believed that the esophagus was in front of the trachea. The author reported 7 reasons why they misunderstood the relative locations of the trachea and esophagus.4) Future problems regarding the broncho-esophageal foreign bodies and their diagnosis, anesthesiology and removal were discussed. Improvement in the flexible broncho-fiber scope, X-ray diagnosis and methods of anesthesia, and new removal methods for the bronchoesophageal foreign bodies are required.