What if i swallow a fishbone

This is the second most common site of FB impaction within the esophagus. Note the close proximity to the aortic lumen which would partly explain the high incidence of vascular injuries within the mediastinum. Accidentally ingested FBs may not be remembered by patients. Within the bowel, the most common sites of perforation are the ileum, the ileocecal junction and the rectosigmoid colon.

When looking for FBs below the diaphragm, plain radiographs are generally not of sufficient diagnostic value to be used routinely as they do not show the culprit FB in most cases. This is in contrast to metallic objects and chicken bones that are invariably seen on plain radiographs.

Firstly, not all FBs are sufficiently radiopaque to be seen on radiographs. In addition, the presence of fluids or large soft tissue masses or the use of a high kV exposure setting may further obscure the faint calcifications. Evaluation with ultrasonogram USG is also not always useful as the examination may be hampered by patient obesity and bowel gases. It also relies heavily on the skill of the operator.

If seen, the FB may appear as a thin, linear hyperechoic structure with distal acoustic shadowing. In general, USG is more useful in thinner patients and when the perforation is relatively superficial. CT scan is the most sensitive modality when looking for an FB, and it remains the preferred investigation in such cases. In fact, the most common reason for overlooking an FB is the lack of observer awareness.

Following FB ingestion, the most common complication below the diaphragm is perforation of a hollow viscus [ Figure 8 ]. On CT scan, the region of perforation may be identified as a thickened bowel segment, with regional fatty infiltration or bowel obstruction.

Localized pneumoperitoneum may be seen in up to half of the patients. Sequential axial contrast-enhanced CT scans through the lower abdomen show a linear radiodense FB arrow in the distal ileum. It can be seen to traverse the thickened bowel wall. Surrounding stranding of the mesenteric fat is noted. There was no pneumoperitoneum. Axial contrast-enhanced CT scans show focal fat stranding and localized pneumoperitoneum in relation to the ileal loops white arrow in A.

There is associated dilatation of the bowel loops, suggesting obstruction. The FB is seen distally in the large bowel black arrow in B , reemphasizing the importance of closely scrutinizing the bowel loops distal to the inflamed segments.

In some cases, the FB may migrate caudally and may be seen situated away from the site of perforation [ Figure 10 ]. Careful scrutiny of the images in such cases usually reveals the culprit FB and it is worth looking for, especially if no other cause of bowel perforation is apparent.

It is also important to remember that there may be more than one site of perforation. Small bowel perforation without obstruction. Axial A and coronal B contrast-enhanced CT scans show localized pneumoperitoneum and fat stranding in relation to focally thickened distal ileal loops black arrows in A.

The FB however, has since passed distally into the large bowel and can be easily overlooked on the axial images white arrow in A. Note that the FB is fairly conspicuous on the coronal images white arrow in B.

Despite the clear superiority of CT scan over plain radiography and USG, there are certain potential pitfalls that must be kept in mind. The faint calcification of FB may be obscured by oral contrast.

In cases where intravenous contrast has been given, the FB may mimic a small blood vessel[ 1 , 14 ] and can be easily overlooked [ Figure 11 ].

Another potential limitation of CT scan is slice thickness. In such cases, coronal or sagittal reconstructions may be especially useful [ Figure 12 ]. Axial A contrast-enhanced CT scan shows a small hyperdensity, which may be easily overlooked or confused with a vessel black arrow in A , which however is very well appreciated in the sagittal reformatted image arrow in B penetrating through the bowel wall.

Associated segmental bowel wall thickening is seen with presence of a small loculated collection asterisk in B. Non-contrast axial A,B CT scans show a questionable hyperdensity within the esophageal lumen, at the level of the thoracic inlet arrows.

The coronal reconstructed image however clearly shows the presence of a fine linear FB arrow in C. Coronal images are in general more useful in cases of FB since the bone is usually oriented orthogonally to the acquired axial images.

FB perforations may also mimic neoplastic conditions. Sporadic cases of an FB masquerading on imaging as a tongue malignancy,[ 20 ] esophageal mass,[ 21 ] gastric submucosal tumor[ 19 ] and even a locally advanced pancreatic tumor[ 14 ] have been reported.

This is partly due to the intense inflammatory reaction induced and in part due to the lack of observer awareness about the imaging appearance of the FB. In virtually all these cases, a linear, calcified hyperdensity consistent with an FB was seen either at the time of scanning or on retrospective analysis.

Although in most cases the ingested FB uneventfully passes through the GI tract, it has the potential to cause a variety of complications.

Because the history may not always be forthcoming and because patients may present with nonspecific symptoms, FBs are relatively easy to overlook radiologically. A high index of suspicion and a diligent search for the FB are usually rewarding in such cases. Source of Support: Nil. Conflict of Interest: None declared.

National Center for Biotechnology Information , U. Indian J Radiol Imaging. Author information Copyright and License information Disclaimer. Correspondence: Dr. If you have issues with fishbone stuck in your throat, consider visiting Dr. Dennis Chua.

Fishbone stuck for more than 24hours have been shown to result in increased complication rate. If there are symptoms such as fever, blood stained saliva or chest pain, it could lead to serious complications.

Once the fishbone is removed, the puncture wound usually heals quite well. Depending on the condition, oral antibiotics or anti-inflammatory mouth wash may be given to hasten recovery. If the fishbone is left in place for more than a few days, it can start to migrate within the body. A migrated fishbone is a serious emergency that can have life-threatening complications. It can puncture vital organs or even big blood vessels within the body resulting in large amounts of bleeding.

Sometimes foreign bodies that are not bones have been swallowed before and can also get lodged in the throat or esophagus. This was a pill box that was swallowed and was lodged in the esophagus. People can lower their risk of swallowing fish bones by buying fillets, which tend to have fewer bones hiding in them than whole fish do, Healthline says. In addition, taking small bites and eating slowly can help lower the risk.

Originally published on Live Science. Rachael has been with Live Science since She also holds a B. Live Science. Rachael Rettner.