Migrating fish bone presenting as a neck fistula

The case report describes an extremely rare finding of fish bone migration from the aerodigestive tract causing a neck fistula 2 years after its ingestion. Detailed case study and surgical treatment is presented. This case highlights the need for further assessment in presence of a high clinical suspicion of foreign body ingestion with a normal physical examination of the upper aerodigestive tract, to avoid serious and potential life-threatening complications later on.

Using methylene blue as a marker to find and remove tiny metallic foreign bodies embedded in the soft tissues of children: A randomised controlled trial

BACKGROUND

Embedment of metallic foreign bodies in the soft tissues is commonly encountered in the emergency room. Most foreign bodies are easily removed, but removal is difficult if the foreign body is very small or deeply embedded.

OBJECTIVE

To determine the usefulness of methylene blue staining in the surgical removal of tiny metallic foreign bodies embedded in the soft tissue.

METHODS

This prospective study involved 41 children treated between May 2007 and May 2012. The patients were randomly divided into a methylene blue group and a control group. In the control group, foreign bodies were located using a C-arm and removed via direct incision. In the methylene blue group, foreign bodies were located using a C-arm, marked with an injection of methylene blue and then removed surgically. The clinical outcomes, complications, operation time, surgical success rate, incision length, frequency of C-arm use, and length and depth of the foreign body were compared between the two groups.

RESULTS

The surgical success rate was significantly higher in the methylene blue group. The average operation time was significantly shorter in the methylene blue group. The C-arm was used significantly less frequently in the methylene blue group than in the control group. The incision length was significantly shorter in the methylene blue group than in the control group.

CONCLUSIONS

Methylene blue staining facilitated the location and removal of tiny metallic foreign bodies from the soft tissue, and significantly reduced operation time, incision length and radiation exposure compared to the conventional method.

Migration of a fish bone from the upper aerodigestive tract to the skin of the neck: a case report

We describe an unusual case of a migratory foreign body (fish bone) in the neck of a 45-year-old woman. The 2.1-cm bone migrated from the esophagus and traversed through the entire soft tissue of the neck, and it almost extruded through the skin of the neck. With the patient under local anesthesia, the foreign body was easily extracted through an incision over the skin.

Finding nemo: imaging findings, pitfalls, and complications of ingested fish bones in the alimentary canal

In Asian cuisine, fish is often prepared whole with the bones. Accidental fish bone (FB) ingestion is not an infrequently encountered condition in the emergency department. An impacted FB in the alimentary canal can lead to potentially life-threatening complications. For impacted FBs that cannot be visualized clinically, radiographs and multidetector computed tomography are helpful in localizing the FB, evaluating for complications, and planning treatment. In this pictorial essay, we illustrate the spectrum of radiological findings of impacted FBs, common imaging pitfalls, and complications. Finally, we highlight the imaging findings that are important to the clinician in planning treatment.

A prolonged buried fish bone mimicking Ludwig angina

Most migrated foreign bodies in the neck were removed immediately in patients with persistent symptoms. It is a rare condition that a fish bone was buried for a prolonged time in the tongue with little discomfort. We report a unique case of an ingested fish bone lodged in the tongue for 16 months until infection ensued. Ludwig angina was considered first because the patient had fever, odynophagia, swelling of the tongue, and mouth floor. The fish bone buried in the tongue was incidentally found on the computed tomography scan and successfully removed by surgical exploration. Although dental infection is the most common underlying cause in Ludwig angina, embedded foreign body should be considered as one of the pathogenesis. On the other hand, computed tomography scan can be useful in identifying extraluminal migration of fish bones in the neck.

[Migration and extrusion from the upper digestive tract to the skin of the neck of a foreign body (fish bone)]

Foreign bodies ingestion is a common problem seen at emergency rooms and mostly involved are fish and chicken bones. The diagnosis can be difficult because of the age of the patient (children and older patients with dental prosthesis). The shape of the foreign body leds to the course of the pathology, with possible mayor complications like migration into the fascial spaces of the neck, retropharyngeal abscess and perforation of the pharynx or esophagus which have the potential to cause morbidity and mortality. We present a 88-year-old lady who swallowed a 3 cm linear sharp fish bone which migrated from the pharynx to the skin of the neck, surfaced through a fistulous orifice and threw out six weeks later. No intervention was needed. A discussion of the management of migrated foreign bodies follows.

An unusual penetrating injury in an infant: straight-pin migration from the back to the stomach

Sharp foreign bodies reach into the abdomen frequently by ingestion and may lead to various complications including perforation. An 11-month-old infant is presented for straight-pin migration into the abdomen with penetration from the back and through the left diaphragm, spleen, and stomach. The infant was treated successfully with a well-organized diagnostic and therapeutic algorithm.