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Fish Bone Foreign Body: The Role of Imaging
Ayala Klein1, Sharon Ovnat-Tamir1, Tal Marom1
1Department of Otolaryngology-Head and Neck Surgery, Assuta Ashdod University Hospital, Ashdod, Israel.
International Archives of Otorhinolaryngology
|January 17, 2019
Summary
Patients under 40 with suspected fish bone impaction may not need CT scans if symptoms are mild, potentially allowing safe discharge without imaging. This approach is based on the low probability of esophageal fish bones in this demographic within 24 hours of ingestion.
Area of Science:
- Otolaryngology and Emergency Medicine
- Diagnostic Imaging in Foreign Body Ingestion
Background:
- Fish bone foreign body (FFB) impaction is a frequent reason for emergency department visits.
- Current diagnostic and treatment strategies for FFB vary.
- Computed tomography (CT) is often used but may be unnecessary in certain patient groups.
Purpose of the Study:
- To identify patients with suspected fish bone impaction who can be safely discharged without CT imaging.
- To reduce unnecessary imaging studies in the emergency department setting.
Main Methods:
- A literature search was conducted using PubMed with relevant Medical Subject Headings (MeSH) terms.
- Included search terms: fish bone, fish foreign body, oropharynx, hypopharynx, esophagus, flexible esophagoscopy, and rigid esophagoscopy.
- 32 English-language papers were identified, including case reports detailing rare complications.
Main Results:
- In patients over 40 with suspected FFB, urgent non-contrast CT is recommended regardless of symptom ambiguity.
- In patients under 40 presenting within 24 hours of ingestion, CT imaging has limited diagnostic value.
- The probability of esophageal fish bones is low in patients under 40 within 24 hours of ingestion.
Conclusions:
- For patients under 40 with suspected FFB and no clinical findings, discharge without imaging may be considered safe.
- This approach aims to avoid unnecessary CT scans in a low-risk demographic.
- Age and time since ingestion are critical factors in determining the need for imaging in suspected FFB cases.
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