Endoscopy 2014; 46(S 01): E216-E217
DOI: 10.1055/s-0034-1364952
Cases and Techniques Library (CTL)
© Georg Thieme Verlag KG Stuttgart · New York

A fish bone perforation of the esophagus

Akira Hokama
1   Department of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus, Okinawa, Japan
,
Kayoko Uechi
1   Department of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus, Okinawa, Japan
,
Eriko Takeshima
2   Department of Endoscopy, University of the Ryukyus, Okinawa, Japan
,
Chiharu Kobashigawa
1   Department of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus, Okinawa, Japan
,
Atsushi Iraha
1   Department of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus, Okinawa, Japan
,
Tetsu Kinjo
2   Department of Endoscopy, University of the Ryukyus, Okinawa, Japan
,
Kazuto Kishimoto
1   Department of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus, Okinawa, Japan
,
Fukunori Kinjo
2   Department of Endoscopy, University of the Ryukyus, Okinawa, Japan
,
Jiro Fujita
1   Department of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus, Okinawa, Japan
› Author Affiliations
Further Information

Corresponding author

Akira Hokama, MD
Department of Infectious, Respiratory, and Digestive Medicine
University of the Ryukyus
207 Uehara, Nishihara
Okinawa 903-0215
Japan   
Fax: +81-98-8951414    

Publication History

Publication Date:
07 May 2014 (online)

 

A 73-year-old man presented with odynophagia and retrosternal pain of 3 days’ duration following a fish meal. Physical examination disclosed normal vital signs and a temperature of 37.2 °C. Laboratory studies showed elevated white blood cells of 13 900/μL and C-reactive protein of 14.8 mg/dL. A computed tomography (CT) of the chest revealed a suspicious fish bone that measured 3 cm in length and had perforated through the esophageal wall ([Fig. 1] and [Fig. 2]). Three-dimensional CT showed the bone (blue matter) penetrating close to the left common carotid artery ([Fig. 3]). Subsequent upper endoscopy revealed only a small submucosal nodule, which was located at 19 cm from the incisors, not an impacted fish bone in the upper esophagus ([Fig. 4]). A tiny white linear scar (arrow) was observed on its top, suggesting the site of perforation ([Fig. 5]). Surgical exploration was performed via a lateral neck incision, and the fish bone was successfully retrieved. The postoperative course was uneventful.

Zoom Image
Fig. 1 An axial computed tomography of the chest disclosed a suspicious fish bone that measured 3 cm in length (black arrow) and had perforated the esophagus (white arrow).
Zoom Image
Fig. 2 A coronal computed tomography of the chest showed the bone (black arrow) and the esophagus (white arrow).
Zoom Image
Fig. 3 Three-dimensional computed tomography showed the bone (blue matter) penetrating close to the left common carotid artery.
Zoom Image
Fig. 4 Upper endoscopy showed only a small submucosal nodule in the upper esophagus not an impacted fish bone.
Zoom Image
Fig. 5 A tiny white linear scar (arrow) was observed on the nodule, suggesting the site of perforation.

Most ingested foreign bodies can pass through the gastrointestinal tract spontaneously. However, 10 % – 20 % of such bodies require nonoperative intervention and 1 % need surgery [1]. Based on a large-scale retrospective study including 316 cases of foreign bodies in the esophagus [2], the most common foreign bodies in the pharynx and the upper esophagus were fish bones. The risk of complications was increased with a longer duration of impaction (> 24 hours), bone type, and longer bone length (> 3 cm). The current case had all of these risk factors. As for endoscopic features of fish bones, most visible bodies can be retrieved by biopsy forceps [3]. Extremely rare cases with imbedded or perforating fish bones may present submucosal tumor-like nodules [4] [5], as in this case.

Endoscopy_UCTN_Code_CCL_1AB_2AC_3AH


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Competing interests: None

  • References

  • 1 Eisen GM, Baron TH, Dominitz JA et al. Guideline for the management of ingested foreign bodies. Gastrointest Endosc 2002; 55: 802-806
  • 2 Sung SH, Jeon SW, Son HS et al. Factors predictive of risk for complications in patients with oesophageal foreign bodies. Dig Liver Dis 2011; 43: 632-635
  • 3 Ihama Y, Hokama A, Iraha A et al. Esophageal perforation by fish bone ingestion. Gastrointest Endosc 2011; 74: 921
  • 4 Chu YC, Chiu HH. A completely imbedded fish bone presenting as an esophageal tumor-like lesion: an unusual presentation. Gastrointest Endosc 2008; 68: 1190-1191 discussion 1191
  • 5 Tomimori K, Nakasone H, Hokama A et al. Liver abscess. Gastrointest Endosc 2004; 59: 397-398

Corresponding author

Akira Hokama, MD
Department of Infectious, Respiratory, and Digestive Medicine
University of the Ryukyus
207 Uehara, Nishihara
Okinawa 903-0215
Japan   
Fax: +81-98-8951414    

  • References

  • 1 Eisen GM, Baron TH, Dominitz JA et al. Guideline for the management of ingested foreign bodies. Gastrointest Endosc 2002; 55: 802-806
  • 2 Sung SH, Jeon SW, Son HS et al. Factors predictive of risk for complications in patients with oesophageal foreign bodies. Dig Liver Dis 2011; 43: 632-635
  • 3 Ihama Y, Hokama A, Iraha A et al. Esophageal perforation by fish bone ingestion. Gastrointest Endosc 2011; 74: 921
  • 4 Chu YC, Chiu HH. A completely imbedded fish bone presenting as an esophageal tumor-like lesion: an unusual presentation. Gastrointest Endosc 2008; 68: 1190-1191 discussion 1191
  • 5 Tomimori K, Nakasone H, Hokama A et al. Liver abscess. Gastrointest Endosc 2004; 59: 397-398

Zoom Image
Fig. 1 An axial computed tomography of the chest disclosed a suspicious fish bone that measured 3 cm in length (black arrow) and had perforated the esophagus (white arrow).
Zoom Image
Fig. 2 A coronal computed tomography of the chest showed the bone (black arrow) and the esophagus (white arrow).
Zoom Image
Fig. 3 Three-dimensional computed tomography showed the bone (blue matter) penetrating close to the left common carotid artery.
Zoom Image
Fig. 4 Upper endoscopy showed only a small submucosal nodule in the upper esophagus not an impacted fish bone.
Zoom Image
Fig. 5 A tiny white linear scar (arrow) was observed on the nodule, suggesting the site of perforation.