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

Document Type : Original

Authors

1 Department of ENT – Head and Neck Surgery, Military Training Hospital Percy,101, Avenue Henri Barbusse 92140, Clamart, France.

2 Emergency Department, Fire Fighting Brigade of Paris, Place Jules Renard 75017, Paris, France.

Abstract

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.

Keywords

Main Subjects


1. Holinger LD. Management of sharp and penetrating foreign bodies of the upper aero-digestive tract. Ann Otol Rhinol Laryn­gol 1990. 99: 684-8.
2. Murty P, Vijendra Si, Ramakrishna S, Fahim As, Varghese P. Foreign bodies in the upper aero-digestive tract. SQU Journal for Scientific Research 2001. 3(2): 117-20.
3. American society for Gastrointestinal endoscopy. Guideline for the management of ingested foreign bodies. Gastrointest Endosc 2002. 55: 802-6.
4. Murty P, Ingle VS, Ramakrishna S, Shah FA, Varghese P. Foreign bodies in the upper aero-digestive tract. J Sci Res Med 2001. 3(2):117-20.
5. Lachaux A, Letard JC, Laugier R, Gay G, Arpurt JP, Boustière C, et al. Recommendations of the French Society of Digestive Endoscopy. The ingested foreign bodies. Acta Endosc 2007. 37:91-3.
6. Wilson RT, Dean PJ, Lewis M. Aortoesophageal fistula due to a foreign body. Gastrointest Endosc 1987. 33: 448-50.
7. Connolly AA, Birchall M, Walsh-Waring GP, Moore-Gillon V. Ingested foreign bodies: patient guided localization is a useful clinical tool. Clin Otolaryngol 1992. 17:520-4.
8. Ikenberry SO, Jue TL, Anderson MA, Appalaneni V, Banerjee S, Ben-Menachem T, et al. Management of ingested foreign bodies and food impactions. Gastrointest Endosc 2011. 73(6): 1085-91.
9. Takada M, Kashiwagi R, Sakane M, Tabata F, Kuroda Y. 3D-CT diagnosis for ingested foreign bodies. Am J Emerg Med 2000.18:192-3.
10. Biswas B, Datta R. retained oesophageal foreign bodies – report of three cases. Indian J Otolaryngol Head Neck Surg 1999. 51(Suppl 1): 15-8.
11. Gmeiner D, von Rahden BH, Meco C, Hutter J, Oberascher G, Stein HJ. Flexible versus rigid endoscopy for treatment of foreign body impaction in the esophagus. Surg Endosc 2007. 21: 2026-9.
12. Lesur G, Vedrenne B, Heresbach D, Arpurt JP, laugier R. Consensus in digestive endoscopy. Materials and conditions for emergency endoscopy. Acta Endosc 2009. 39(6): 468–73.
13. Herranz-Gonzalez J, Martinez-Vidal J, Bardin-Saranderesa C, Vazquez-Barro C. Esophageal foreign bodies in adults. Otolaryngol Head Neck Surg 1991.105: 649-54.
14. Rosch W, Classen M. Fiberendoscopic foreign body removal from the upper gastrointestinal tract. Endoscopy 1972. 4: 193-7.
15. Smith MT, Wong RK. Foreign bodies. Gastrointest Endosc Clin N Am 2007. 17(2):361-82.