A Lodged Barramundi Fish-Bone Stabbing the Piriform Fossa in a Child

Unintentional ingestion of a fish bone is common in children, especially among families with high consumption of seafood. Complications in children are extremely rare. We describe a 3-year-old healthy boy who had a large bone of Barramundi fish lodged in his upper esophagus causing significant distress. Soft tissue neck radiograph revealed a mildly thickened epiglottis and bulbous and hypertrophied adenoid soft tissue. A 21-mm foreign body was noticed. A flexible fiberoptic laryngoscopy revealed a large fish bone emerging from the left piriform fossa and arcing over the left arytenoid to hover over the posterior glottis. The bone was removed during anesthesia induction before a rigid esophagoscopy. The fish-bone entry point was seen stabbing through the edge of the piriform fossa and running down alongside the esophagus, without causing a through and through perforation. Fish bone ingestion can cause significant complications including perforation of the esophagus. Early suspicion of ingestion, radiological investigation, and swift management are important to ensure reduced complication rate in children.