1
Introduction
Fish bone in throat is a frequent problem encountered in the otorhinolaryngology practice. One of the common problems faced in such patients is that of missing fish bone. Here, we are presenting a case report where the bone was missed on the first instance, leading to the retropharyngeal and oropharyngeal cellulitis making the extraction further more difficult and dangerous. Literature review has been done for past 20 years on cases and studies relating to the problem.
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Case report
A 40-year-old gentleman presented to the Department of Otorhinolaryngology and Head & Neck Surgery of the Sri Ramchandra Medical College and Research Institute with the chief complaint of pain in throat and inability to swallow for the past 2 days. A detailed history revealed that the problem started 2 days back when a fish bone got stuck in his throat. He was rushed to a nearby hospital where he was evaluated and an X-ray lateral view neck was done. The X-ray was reported to be normal and, because the patient did not have much pain, was sent back with a course of antibiotics and painkillers. However, his conditioned worsened over the next day, and thereafter, he was unable to swallow his own saliva. He also developed fever.
A thorough examination showed a distressed toxic patient with severe odynophagia. Posterior pharyngeal wall was edematous. A repeat X-ray was done, which showed widening of the prevertebral soft tissue layer pointing toward an impending retropharyngeal abscess ( Fig. 1 ). Detailed evaluation of the X-ray neck lateral view also showed the presence of a linear foreign body in the upper esophageal region. The patient was immediately started on a course of broad spectrum antibiotics that included cefuroxime + sulbactam and Metrogyl. Analgesia and anti-inflammatory cover were provided with injection Voveran. Intravenous fluids were also started. Initial plan was to first allow the inflammation and edema to subside a little with the antibiotics and anti-inflammatory therapy and then to proceed with the extraction. A repeat X-ray the next morning showed formation of a few gas shadows in the retropharyngeal space ( Fig. 2 ). At this point, it was decided to go ahead with the extraction immediately.
Anesthetic opinion was sought. During intubation, the laryngeal inlet was found to be inflamed and edematous so a careful intubation was performed with a size 6.0 cuffed endotracheal tube. Once intubated, a careful esophagoscopy was performed, and the foreign body was located at a level just beyond the cricopharynx. It was grasped using foreign-body forceps and was carefully dislodged and extracted taking care not to cause damage to the esophagus. One big piece of bone with a piece of flesh and 2 leaves were extracted as shown in the picture ( Fig. 3 ). Just at the moment when bone was removed, pus started to trickle from the area, confirming our suspicion of a retropharyngeal abscess. A check esophagoscopy was performed, and the rest of esophagus was found to be normal. Ryle’s tube was inserted and secured. The extubation was uneventful. The patient was kept on Ryle’s tube feed for next 3 days. The same antibiotics were continued. Thereafter, the patient was gradually shifted to oral feed and subsequently discharged in a stable condition.
2
Case report
A 40-year-old gentleman presented to the Department of Otorhinolaryngology and Head & Neck Surgery of the Sri Ramchandra Medical College and Research Institute with the chief complaint of pain in throat and inability to swallow for the past 2 days. A detailed history revealed that the problem started 2 days back when a fish bone got stuck in his throat. He was rushed to a nearby hospital where he was evaluated and an X-ray lateral view neck was done. The X-ray was reported to be normal and, because the patient did not have much pain, was sent back with a course of antibiotics and painkillers. However, his conditioned worsened over the next day, and thereafter, he was unable to swallow his own saliva. He also developed fever.
A thorough examination showed a distressed toxic patient with severe odynophagia. Posterior pharyngeal wall was edematous. A repeat X-ray was done, which showed widening of the prevertebral soft tissue layer pointing toward an impending retropharyngeal abscess ( Fig. 1 ). Detailed evaluation of the X-ray neck lateral view also showed the presence of a linear foreign body in the upper esophageal region. The patient was immediately started on a course of broad spectrum antibiotics that included cefuroxime + sulbactam and Metrogyl. Analgesia and anti-inflammatory cover were provided with injection Voveran. Intravenous fluids were also started. Initial plan was to first allow the inflammation and edema to subside a little with the antibiotics and anti-inflammatory therapy and then to proceed with the extraction. A repeat X-ray the next morning showed formation of a few gas shadows in the retropharyngeal space ( Fig. 2 ). At this point, it was decided to go ahead with the extraction immediately.
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