Pulmonary artery penetration due to fish bone ingestion: A rare case report

Accidental fish bone ingestion is a common manifestation at emergency departments. In most cases, ingested foreign bodies usually pass uneventfully through the gastrointestinal tract and complications only present in less than 5% of all patients. In this report, we present the first documented case of pulmonary artery injury due to a fish bone in a 63-year-old male patient hospitalized with hemoptysis after accidentally swallowing a fish bone 30 days ago. This patient subsequently had surgery and endoscopy to safely remove the foreign body and then recovered well on a follow-up examination. For cases of fish bone ingestion, contrast-enhanced chest computed tomography is one of the most essential tools to assess vascular problems and associated mediastinal infections-risk factors for life-threatening and long-term recurrent inflammation. Reconstructing planes along the foreign body axis and changing windows when analyzing CT scans is necessary to avoid missing lesions and dilemmas.

Bedside ultrasound-guided water injection assists endoscopically treatment in esophageal perforation caused by foreign bodies: A case report

BACKGROUND

Fishbone migration from the esophagus to the neck is relatively uncommon in clinical practice. Several complications secondary to esophageal perforation after ingestion of a fishbone have been described in the literature. Typically, a fishbone is detected and diagnosed by imaging examination and is usually removed by a neck incision.

CASE SUMMARY

Herein, we report a case of a 76-year-old patient with a fishbone in the neck that had migrated from the esophagus and that was in close proximity to the common carotid artery, and the patient experienced dysphagia. An endoscopically-guided neck incision was made over the insertion point in the esophagus, but the surgery failed due to having a blurred image at the insertion site during the operation. After injection of normal saline laterally to the fishbone in the neck under ultrasound guidance, the purulent fluid outflowed to the piriform recess along the sinus tract. With endoscopic guidance, the position of the fish bone was precisely located along the direction of liquid outflow, the sinus tract was separated, and the fish bone was removed. To the best of our knowledge, this is the first case report describing bedside ultrasound-guided water injection positioning combined with endoscopy in the treatment of a cervical esophageal perforation with an abscess.

CONCLUSION

In conclusion, the fishbone could be located by the water injection method under the guidance of ultrasound and could be accurately located along the outflow direction of the purulent fluid of the sinus by the endoscope and was removed by incising the sinus. This method can be a nonoperative treatment option for foreign body-induced esophageal perforation.

Dynamics of the natural genesis of β-TCP/HAp phases in postnatal fishbones towards gold standard biocomposites for bone regeneration

The search for gold-standard materials for bone regeneration is still a challenge in reconstruction surgery. The ratio between hydroxyapatite (HAp) and β-tricalcium phosphate (β-TCP) in biphasic calcium phosphate ceramics (BCPs) is one of the most important factors in osteoinduction promotion and controlled biodegradability, configurating what is currently considered as a possible gold standard material for bone substitution in reconstructive surgery. Exploring the natural genesis of the HAp and β-TCP phases in fishbones during their postnatal growth, this study developed a biphasic bioceramic obtained from the calcination of Nile tilapia (Oreochromis niloticus) bones as a function of their ages. The natural genesis dynamics of the structural evolution of the β-TCP and HAp phases were characterized by physicochemical methods, taking into account of the age of the fish and the material processing conditions. Thermal analysis (TGA / DTA) showed complete removal of the organic matter and transitions associated with the transformation of carbonated hydroxyapatite (CDHA) to HAp and β-TCP phases. After calcination at 900 °C, the material was characterized by: X-ray diffraction (XRD) and refinement by the Rietveld method; Fourier Transform Infrared Spectroscopy with Attenuated Total Reflection (FTIR-ATR); Raman spectroscopy; Scanning Electron Microscopy (SEM) and Flame Atomic Absorption Spectroscopy (FAAS). The analysis allowed identification and quantitative estimate of the variations of the HAp and β-TCP phases in the formation of the BCPs. The results showed that the decrease in β-TCP against the increase in the HAp phases is symmetrical to the dynamics of the natural genesis of these phases, surprisingly maintaining the balanced phase proportion even when bones of young fishes were used. The microstructure analysis confirms the observed transformation. In addition, in vivo tests demonstrated the osteoinductive potential of BCP scaffolds implanted in an ectopic site, and their remarkable regenerative functionality, as bone graft, was demonstrated in alveolar bone after tooth extraction. MTT cytotoxicity assay for BCP samples for MC3T3-E1 pre-osteoblasts and L929 fibroblasts cells showed viability equal or higher than 100%. A logistic empirical model is presented to explain the three stages of HAp natural formation with fish age and it is also compared to the fish size evolution.

Pesky Pesce: A Forgettable Fish Dinner with a Late Surprise, a Perianal Abscess

Clinical presentation after ingestion of foreign body is a common finding in surgical practice. Perianal sepsis due to a foreign body is, usually, secondary to introduction via the trans-anal route. The case here reported is extremely rare since an ingested fishbone passed asymptomatically through most of the gastrointestinal tract, with resultant late-onset ischiorectal abscess. Moreover, clinical evidence of the perianal abscess manifested one month after the fishbone had been ingested. The final localization of the fishbone-lying anterior to the sacrum-complicated the preoperative and intraoperative detection of the ingested foreign body.

A fatal perforation of the distal ileum from an ingested fish bone: A case report

INTRODUCTION AND IMPORTANCE

Foreign body-induced perforations of the ileum are rare consequences among adults.

PRESENTATION OF CASE

This is a case report of a delayed presentation of an ileal perforation and concurrent faecal peritonitis presented as an acute abdomen, resultant from an ingested fishbone, which led to fatality despite urgent laparotomy.

CLINICAL DISCUSSION

Perforations following ingested foreign bodies are frequently unanticipated clinically, and diagnosed during advanced imaging studies or surgical interventions. Endoscopy, laparoscopy, and laparotomy have been used during surgical management in reported cases; however, prior early identification is pivotal for good outcomes as delayed presentations and delayed diagnosis carry a poorer prognosis.

CONCLUSION

Despite fish bones being frequent foreign bodies in the gastrointestinal tract and the majority causing no life-threatening adverse effects, they are the leading foreign bodies instigating gastrointestinal perforations. A high degree of suspicion is required when attending to patients with suspected gastrointestinal perforations and absent typical findings in routine imaging, where fish bones could be the aetiology.

Successful preoperative identification of fish bone causing appendicitis using 3-dimensional multidetector-CT

A 79 years male with fishbone-induced acute appendicitis was treated surgically with laparoscopic procedure. In preoperative diagnostic study, 3-dimensional multidetector-computed tomography (3D-MDCT) demonstrated the foreign body in the appendix and 3D-reconstructed images seemed fishbone with sharp-pointed dorsal fin directing to the tip of the appendix. With these findings, surgical indication of appendectomy was confirmed and laparoscopic appendectomy was performed. He made a full recovery and was discharged in a satisfactory condition following 7 days of post-operative treatment. From this case experience, 3D-MDCT seems helpful to visualize details of foreign bodies in the appendix, and valuable to confirm surgical indication of complicated acute appendicitis.

Liver abscess in the caudate lobe caused by a fishbone and treated by laparoscopy: a case report

Background

Ingestion of fish bones leading to gastric perforation and inducing abscess formation in the caudate lobe of the liver is very rare.

Case presentation

A 67-year-old man presented to our hospital with a 2-day history of subxiphoid pain. There were no specific symptoms other than pain. Laboratory tests showed only an increase in the number and percentage of neutrophils. Contrast-enhanced Computerized tomography (CT) of the abdomen showed two linear dense opacities in the gastric cardia, one of which penetrated the stomach and was adjacent to the caudate lobe of the liver, with inflammatory changes in the caudate lobe. We finally diagnosed his condition as a caudate lobe abscess secondary to intestinal perforation caused by a fishbone based on the history and imaging findings. The patient underwent 3D laparoscopic partial caudate lobectomy, incision and drainage of the liver abscess, and fishbone removal. The procedure was successful and we removed the fishbone from the liver. The patient was discharged on the 9th postoperative day without other complications.

Conclusions

Liver abscess caused by foreign bodies requires multidisciplinary treatment. Especially when located in the caudate lobe, we must detect and remove the cause of the abscess as early as possible. Foreign bodies that perforate the gastrointestinal tract can penetrate to the liver and cause abscess formation, as in this case. When exploring the etiology of liver abscesses, we should investigate the general condition, including the whole gastrointestinal tract.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12893-021-01457-z.

Fishbone foreign body ingestion in duodenal papilla: a cause of abdominal pain resembling gastric ulcer

Background

Foreign body ingestion is a common clinical problem. The upper esophagus is the most common site of foreign body, accounting for more than 75% of all cases, but cases with a foreign body in the duodenal papilla or common bile duct are rarely reported.

Case presentation

Herein, we report a rare case that a patient’s abdominal pain resembling gastric ulcer was caused by a 3 cm long fishbone inserted into the duodenal papilla.

Conclusion

Fishbone inserted into the duodenal papilla can cause an abdominal pain resembling gastric ulcer. Endoscopy is useful for the diagnosis and treatment of fishbone ingestion in clinical.

Misdiagnosis of peripheral abscess caused by duodenal foreign body: a case report and literature review

Background

The induction of chronic inflammation, perforation, and abscess by foreign bodies (FBs) in adults is uncommon. We present a delayed diagnosis case for a patient who had a fishbone stuck in the duodenal bulb, resulting in chronic abdominal pain for nearly 3 months. We present the diagnosis and treatment procedures for chronic patients, which differ from those for acute and emergency FB ingestion, and also summarize the characteristics of such patients through a systematic literature review.

Case presentation

A 68-year-old woman was brought to our hospital with repeated right upper abdominal pain lasting for 3 months and aggravation for 9 h. Computed tomography (CT) showed a streaky high-density shadow (approximately 3 cm in length) on the posterior wall of the gastric antrum extending outside the wall. Endoscopic ultrasonography showed hyperechoic space with a cross-section of approximately 0.1 × 0.1 cm in the deep submucosal layer of the local stomach, accompanied by an acoustic shadow in the rear. The possibility of a fishbone as well as perforation was considered and the object was removed using FB forceps. Fasting as well as acid inhibition and anti-infection medication were prescribed for the patient. She eventually recovered and was discharged from the hospital.

Conclusion

Endoscopic intervention can be recommended as the first option for patients with gastrointestinal FBs.

Gastrointestinal perforation caused by ingested fish bone. Computed tomography findings in 58 patients

CONTEXT AND OBJETIVE

Fish bones (FB) are the most commonly ingested objects and the most common cause of foreign body perforation of the GI tract. Patients present with varied and nonspecific clinical presentations. The inability to obtain a history of FB ingestion and its wide spectrum of nonspecific clinical presentations makes dietary FB perforation extremely difficult to diagnose, being a laparoscopic or surgical diagnosis. The aim of our study is to describe radiological features in CT that will alert you to look for the FB and then make an accurate presurgical diagnosis.

MATERIALS AND METHODS

All patients (n=58) with radiological diagnosis of gastrointestinal perforation caused by fish bone detected by CT between 2007 to 2017 were retrospectively reviewed. Inclusion criteria were: fish bone located beyond the esophagus, radiological diagnosis by CT and confirmation by surgery, endoscopy or radiological control. Descriptive analysis was made. Radiological features were studied including radioopaque foreign body, mural thickness, fatty infiltration or extraluminal air bubbles. Also potential complications were assessed.

RESULTS

There were 58 patients, 39 men and 19 women, with an average age of 70. Ileon was the most frequent site of perforation (20 patients). 100% showed regional fatty infiltration, 98% included foreign body, 45% had mural thickening and 20% localized extraluminal air bubbles. 15 abscess were found (3 in the liver) and just 5 showed pneumoperitoneum.

CONCLUSION

Fatty infiltration is the feature more common. Therefore, if fatty infiltration is seen in isolation radiologist should look for foreign body.

Acute obstructive cholangitis due to fishbone in the common bile duct: a case report and review of the literature

Background

Choledocholithiasis is an endemic condition in the world. Although rare, foreign body migration with biliary complications needs to be considered in the differential diagnosis for patients presenting with typical symptoms even many years after cholecystectomy, EPCP, war-wound, foreign body ingestion or any other particular history before. It is of great clinical value as the present review may offer some help when dealing with choledocholithiasis caused by foreign bodies.

Case presentation

We reported a case of choledocholithiasis caused by fishbone from choledochoduodenal anastomosis regurgitation. Moreover, we showed up all the instances of choledocholithiasis caused by foreign bodies published until June 2018 and wrote the world’s first literature review of foreign bodies in the bile duct of 144 cases. The findings from this case suggest that the migration of fishbone can cause various consequences, one of these, as we reported here, is as a core of gallstone and a cause of choledocholithiasis.

Conclusion

The literature review declared the choledocholithiasis caused by foreign bodies prefer the wrinkly and mainly comes from three parts: postoperative complications, foreign body ingestion, and post-war complications such as bullet injury and shrapnel wound. The Jonckheere-Terpstra test indicated the ERCP was currently the treatment of choice. It is a very singular case of choledocholithiasis caused by fishbone, and the present review is the first one concerning choledocholithiasis caused by foreign bodies all over the world.

Marine Waste Utilization as a Source of Functional and Health Compounds

Consumer demand for convenience has led to large quantities of seafood being value-added processed before marketing, resulting in large amounts of marine by-products being generated by processing industries. Several bioconversion processes have been proposed to transform some of these by-products. In addition to their relatively low value conventional use as animal feed and fertilizers, several investigations have been reported that have demonstrated the potential to add value to viscera, heads, skins, fins, trimmings, and crab and shrimp shells by extraction of lipids, bioactive peptides, enzymes, and other functional proteins and chitin that can be used in food and pharmaceutical applications. This chapter is focused on reviewing the opportunities for utilization of these marine by-products. The chapter discusses the various products and bioactive compounds that can be obtained from seafood waste and describes various methods that can be used to produce these products with the aim of highlighting opportunities to add value to these marine waste streams.

Fishbones in the Upper Aerodigestive Tract: A Review of 24 Cases of Adult Patients

INTRODUCTION

We present a retrospective study series and discussion of the current literature to discuss the management of fishbones in the upper aerodigestive tract.

MATERIALS AND METHODS

From January 2013 to July 2016, all patients referred to our referral center because of a fishbone in the upper aerodigestive tract were analysed.

RESULTS

Of the 24 patients, 95% of them reported discomfort in the throat. It was noted that 58% of physical examinations and nasofibroscopy results were normal. Ten fishbones were found in the upper aerodigestive tract. They were removed by foreign body forceps or by endoscopy depending on the location. Foreign body-related complications were not observed. Ten patients with no identifiable fishbone had no symptoms after 48 hours. Other patients, including the 10 patients with the fishbone removed, were asymptomatic after 10 days.

CONCLUSION

From our experience, we recommend a systematic nasofibroscopy. If it is normal, the patient is assessed at 48h. The complementary investigation by CT scan and/or oesophagoscopy must be reserved in cases of suspicion of oesophageal localization or complication. Otherwise, rigid or flexible endoscopy may be performed when laryngoscopy is unsuccessful or for the treatment of foreign bodies lodged below this area.

Abdominal manifestations of fishbone perforation: a pictorial essay

PURPOSE

The present article provides an overview of the spectrum of abdominal presentations of fishbone (FB) ingestion and its complications.

METHODS

In image data from 9 patients, FB perforations were found in different levels of the gastrointestinal tract (GIT), including duodenal, jejunal, and sigmoid perforations; in 4 asymptomatic patients, FBs were observed in the mesentery, falciform ligament, and intestinal bowel.

RESULTS

The main imaging features of FB perforation were focal gastric or intestinal wall thickening, fat stranding, bowel obstruction, ascites, localized pneumoperitoneum, intra-abdominal abscess, liver abscess, and a linear hyperdense structure in the abdominal cavity in the GIT or within a parenchymal organ often surrounded by inflammatory changes. Free pneumoperitoneum was rare.

CONCLUSION

Although in most cases, a FB does not cause any serious complications, an inflammatory process and complications may occur when it perforates the stomach or bowel loops. Radiologists need to be aware of the possibility of FB perforation, especially in high-risk patients, because it is not always considered in the differential diagnosis by referring physicians and can mimic other inflammatory conditions and tumoral lesions.

Fishbone Perforated Appendicitis

Ingested foreign bodies tend to pass through the gastrointestinal tract without incidence, and vast majority of cases do not need intervention. Rarely, these foreign bodies drop into the appendix and not likely to re-enter the normal digestive tract. We describe a case of a 72-year-old male patient who presented with right iliac fossa pain of 3-day duration. Clinical examination suggested classic acute appendicitis. Blood test results revealed leukocytosis. Computed tomography of the abdomen and pelvis showed evidence of acute appendicitis and a linear hyperdensity (foreign body) perforating the appendix. The patient was managed successfully with prompt laparoscopic appendectomy and removal of the foreign body which was confirmed to be a fish bone measuring about 10mm. While imaging diagnosis of fishbone in the appendix has been published, reports are few. To the best of the author's knowledge, fishbone induced perforated appendicitis has been described only in 2 cases (including this case) in the literature.

Tongue abscess induced by embedded remnant fishbone

The authors reported a 56-year-old man with progressive pain over left bottom of oral cavity involving tongue for 3 days. He had a puncture history of tongue by fishbone, which was immediately removed 3 weeks ago. The subsequent contrast-enhanced computed tomography scan of neck disclosed an abscess formation with a faint linear radiopaque material inside, consisting with remnant fishbone retention. The patient was treated conservatively with intravenous antibiotics, followed by an uneventful course during subsequent follow-up for more than 9 months until now. Tongue abscess is a rare but potentially life threatening clinical entity. Foreign body puncture-related tongue abscess should be listed as a differential diagnosis in cases with acute tongue swelling.

Delay in diagnosis and lessons learnt from a case of abdominal wall abscess caused by fishbone perforation

Complications following foreign body (FB) ingestion are an uncommon clinical problem. A 59-year-old man presented with a 4-week history of left iliac fossa pain and 1 episode of dark red blood mixed with stools. Inflammatory markers were elevated, and computed tomography (CT) of the abdomen and pelvis showed an ill defined abdominal wall inflammatory collection in close contact with the small bowel loops. He was treated with antibiotics, and follow-up CT, colonoscopy and small bowel enema were mostly unremarkable. The patient presented again ten months later with left iliac fossa cellulitis and fever. Multiplanar CT (the patient's fourth scan) demonstrated a 10cm abdominal wall collection with a linear hyperdense structure in the collection. The radiologists suspected a FB and on close scrutiny of the previous scans, they noted it to have been present on all of them. A targeted incision led to the removal of a 3cm fishbone from the collection. This case highlights the need to consider the possibility of a FB being the underlying cause in any unexplained intra-abdominal or abdominal wall inflammatory process so that the diagnosis is made in a timely manner.

Lateral Soft Tissue X-ray for Patients with Suspected Fishbone in Oropharynx, A thing in the past

INTRODUCTION

Fishbone is the most common foreign body found in the oropharynx. Conventionally patients with suspected fishbone in the throat would have mirror laryngoscopy followed by lateral soft tissue X-ray to look for the fishbone or observe impacts caused by the fishbone i.e. soft tissue swelling or air in upper esophagus. However, the most common site of fishbone impact is the suprahyoid area, which contains high soft tissue and bony density. This makes X-rays less reliable, especially because not all fish have radio-opaque bones. With the advent of fibreoptic nasendoscopy (FNE) and improved access to CT scan, more reliable tools exist to treat patients with suspected fishbone in the oropharynx.

MATERIALS AND METHODS

A retrospective study, looking at 698 lateral soft tissue X-rays was performed. This study was conducted in Addenbrookes Hospital, Cambridge (UK) between December 1st, 2004 and February 28th, 2011 using picture archiving and communication systems (PACS). All the radiology reports were reviewed and all the lateral soft tissue X-ray requests for foreign bodies other than fish bones were excluded.

RESULTS

Of the 698 lateral soft tissue X-rays performed between December 1st, 2004 and February 28th, 2011, only 229 (32.8%) were suspected to involve a fishbone in the throat. Amongst those requested for suspected fishbone injury, only 23 (10%) cases were reported by the radiologist as positive for fishbone. Of the 23 patients with a positive finding on X-ray, 13 had negative FNE and were discharged from the hospital, while 5 had fishbone which were visualized using fibreoptic nasendoscope and removed. One patient had an appointment in order to be reviewed in the clinic, but did not show up. The notes for 4 patients were not found; however, there were no records on the hospital intranet suggesting that they had been to the operating room for an ENT procedure related to fishbone. Therefore, it is fair to assume that either there was no fishbone to be found or it was picked up during fibreoptic nasendoscopy and removed under local anesthesia.

CONCLUSION

Requesting lateral soft tissue X-ray is not beneficial in cases with a suspected fishbone in the oropharynx when fibreoptic nasendoscope is readily available.

Gastric foreign body granuloma caused by an embedded fishbone: A case report

Fishbones are the most commonly ingested foreign bodies that cause gastrointestinal tract penetration. However, fishbones embedded in the gastrointestinal tract that lead to foreign body granulomas that mimic submucosal tumors are rare. Herein, we describe a 56-year-old woman who presented with a 20-day-history of upper abdominal pain. Endoscopy revealed an elevated lesion in the gastric antrum. An abdominal computed tomography scan showed a mass in the gastric antrum and a linear calcified lesion in the mass. An endoscopic ultrasonography examination revealed a 3.9 cm × 2.2 cm, irregular, hypoechoic mass with indistinct margins in the muscularis propria layer. The patient was initially diagnosed as having a submucosal tumor, and subsequent surgical resection showed that the lesion was a foreign body granuloma caused by an embedded fishbone. Our case indicated that the differential diagnosis of a foreign body granuloma should be considered in cases of elevated lesions in the gastrointestinal tract.