Ingested bones

Dr Daniel J Bell and Dr Henry Knipe et al.

Ingested bones that become lodged in the throat or gastrointestinal tract are a common presentation to the emergency department. Recognition is important because these cases can be potentially fatal. 

Patients may present with a 'foreign body' feeling in the throat after eating fish but the rates of actual fish bone presence is ~20%. They are most commonly lodged in the oropharynx 1. Less commonly other bones are ingested, such as chicken or pork.

Plain radiograph
  • lateral neck radiograph
    • sensitivity of direct visualisation of fish bone is low at ~ 35% (range 25-39%) 1, 2, 3
      • fish bones have variable opacity, depending on species of fish 2
      • can be obscured by soft tissue swelling or fluid 2
    • indirect signs 1
      • prevertebral soft tissue swelling (develops 3-12 hours after ingestion)
      • soft tissue or oesophageal gas
  • abdominal radiograph
CT
  • more sensitive (~95%) than plain films in detection of ingested fish bones 2, 3
  • can be mistaken for normal structures or obscured by oral contrast 2

Most ingested foreign bodies usually pass without complications within a week of ingestion with perforations being rare, occurring in <1% of patients. However, fish bones are the most common cause of perforation 2 and the most common site of perforation is the terminal ileum followed by the duodenum and rectosigmoid 6, 7.

Share article

Article information

rID: 27907
Section: Gamuts
Synonyms or Alternate Spellings:
  • Fish bone in the throat
  • Fish bones in the throat
  • Fish bone in gastro-intestinal tract
  • Ingested fish bones
  • Ingested fish bone
  • Chicken bone in the throat
  • Chicken bones in the throat

Support Radiopaedia and see fewer ads

Cases and figures

  • Drag
    Case 1
    Drag here to reorder.
  • Drag
    Case 2
    Drag here to reorder.
  • Drag
    Pneumomediastinum
    Case 3: soft tissue gas from fish bone
    Drag here to reorder.
  • Drag
    Case 4
    Drag here to reorder.
  • Drag
    Case 5
    Drag here to reorder.
  • Drag
    Case 6: a large animal bone
    Drag here to reorder.
  • Drag
    Case 7
    Drag here to reorder.
  • Drag
    Case 8: fish bone with oesophageal perforation
    Drag here to reorder.
  • Drag
    Case 9: resulting in liver abscess
    Drag here to reorder.
  • Drag
    Airway is not com...
    Case 10: with oesophageal rupture
    Drag here to reorder.
  • Updating… Please wait.
    Loadinganimation

    Alert accept

    Error Unable to process the form. Check for errors and try again.

    Alert accept Thank you for updating your details.