Revision 19 for 'Ingested bones'

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Ingested bones

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. 

Pathology

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.

Radiographic features

Plain radiograph
  • lateral neck radiograph
    • sensitivity of direct visualization of fish bones is low at ~35% (range 25-39%) 1,2,3
      • fish bones have variable opacity, depending on the 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 esophageal 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

Treatment and prognosis

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.

See also

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