Value of radiography in the management of possible fishbone ingestion

A retrospective study was performed on 42 consecutive patients to examine the value of radiography in the management of complaints of fishbone ingestion. All patients underwent an oral examination followed by radiographic examination with plain films, barium swallows, barium and water swallows, and an endoscopic examination. All radiographs were reviewed by two unbiased, experienced radiologists. Of the 7 cases with fishbone found at endoscopic examination, only two (29%) bones were seen by the primary radiologist and 5 (71%) by the reviewing radiologists. Except for one case in which all three radiologists detected a fishbone that passed during the examination, and thereby was not found on endoscopy, no fishbones were found at the radiographic examination that were not seen on the endoscopic examination. Thus, radiography added no valuable information but only delayed the endoscopic examination with ensuing removal of the foreign body, which had to be performed regardless of the outcome of the radiographic examination. Therefore, we suggest that patients with a short history of complaints of fishbone ingestion, ie, 48 hours or less, should first be evaluated with oral and endoscopic examination.