A completely imbedded fish bone presenting as an esophageal tumor-like lesion: an unusual presentation - 23/08/11
Doi : 10.1016/j.gie.2008.07.020
Lawrence J. Brandt, MD, Associate Editor for Focal Points
| Commentary Ingested fish bone is the most common foreign body in the adult upper-GI tract. Fortunately for the gastroenterologist, most fish bones get stuck in the oropharynx and are within the province of the ear, nose, and throat (ENT) surgeon. Those fish bones that make their way distally usually lodge in the upper esophagus and present with a sticking pain at the site of penetration. Easy to suspect clinically, they are difficult to find radiologically because many are translucent, and even bones that are radiologically visible ex vivo commonly are obscured by soft tissues and by laryngeal calcification; hence, plain films are not all that useful diagnostically. In the era before endoscopy, a cotton pledget study often was done: the pledget was dipped in barium and swallowed, the hope being it would get stuck on a bone fragment that projected into the lumen, thereby allowing the bone to be detected and subsequently removed. Today, CT scanning most often is done, but here too, there is poor correlation between the radiodensity of fish bones and their visibility. Usually fish bones pass without incident, but complications can be catastrophic, including neck and thyroid abscesses, mediastinitis, esophago-aortic or esophago-carotid fistulas, and even rectal perforation. In this case, the inflammatory reaction that surrounded the ingested bone formed a mass that served to help the endoscopist find and remove the bone. In Moby Dick, Melville wrote, “chowder for breakfast, chowder for dinner, and chowder for supper, till you began to look for fish-bones coming through your clothes.” Now that is what I call a perforation! Lawrence J. Brandt, MD Associate Editor for Focal Points |
© 2008
American Society for Gastrointestinal Endoscopy. Pubblicato da Elsevier Masson SAS. Tutti i diritti riservati.
Vol 68 - N° 6
P. 1190-1191 - dicembre 2008 Ritorno al numero
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