Abstract

To the Editor:

A 57-year-old man with no prior medical history complained of a foreign body sensation and a stabbing pain in the right side of the neck after accidental ingestion of a fish bone at breakfast. He attempted to dislodge the fish bone by swallowing some rice, but his discomfort was persistent and worsened upon swallowing. The physical examination was unremarkable. A lateral neck radiograph revealed a vertically-orientated linear opacity at the level of the fifth and sixth cervical vertebrae, associated with prevertebral soft tissue swelling (Fig.). A flexible esophagoscopy showed a tiny erosive lesion with surrounding submucosal hematoma in the upper esophagus 14 cm from the central incisor, but there was no evidence of any foreign body in the esophagus, even after carefully probing the area with biopsy forceps. A rigid esophagoscopy under general anesthesia still failed to find the swallowed foreign body. An urgent computed tomography (CT) scan of the neck revealed the ingested fish bone to be present between the cricoid cartilage and the cervical vertebra. Neck exploration was performed, with palpation of the embedded fish bone through the esophageal wall to identify its location (because the embedded fish bone was situated completely intramurally, without perforating the esophageal wall). Esophagomyotomy was undertaken, and a 3.5 cm long fish bone was successfully retrieved. The patient was discharged on the seventh postoperative day without further complications.