• MAUDE
• Manufacturer and User Facility Device Experience
• adverse event
• device malfunction
• medical device
• rhinolaryngoscope

• Humans
• Equipment Failure/statistics & numerical data
• Databases, Factual
• United States
• Product Surveillance, Postmarketing
• United States Food and Drug Administration
• Laryngoscopes/adverse effects

• abscess
• fishbone
• foreign body
• microbiota
• radiology

• Case report
• Fish bone
• Foreign body migration
• Multiplanar reconstruction
• Serial computer tomography

• Humans
• Aged
• Male
• Female
• Middle Aged
• Animals
• Tomography, X-Ray Computed
• Fishes
• Foreign Bodies/diagnostic imaging
• Foreign Bodies/surgery
• Foreign-Body Migration/diagnostic imaging
• Foreign-Body Migration/surgery
• Bone and Bones/diagnostic imaging

• YOLO
• computer vision
• deep learning
• fish bones
• laryngoscopy

• Animals
• Humans
• Laryngoscopy
• Laryngoscopes
• Algorithms
• Foreign Bodies/diagnostic imaging
• Artificial Intelligence

• 2022ZD0160601 National Key Research and Development Program of China
• 62002356 National Natural Science Foundation of China
• 62076235 National Natural Science Foundation of China
• 62206290 National Natural Science Foundation of China

• Case report
• Esophageal foreign body
• Fishbone
• Hemoptysis
• Lung infection
• Pulmonary artery penetration

• Case Report
• endoscopy
• esophageal perforation
• foreign body
• post-traumatic aneurysm of aorta

• accidental pharyngeal fishbone ingestion
• difficult fishbones
• risk factors
• video-guided laryngoscope

• Humans
• Male
• Female
• Pharynx
• Neck Pain
• Prospective Studies
• Foreign Bodies/complications
• Risk Factors
• Eating

• fishbone
• horseshoe abscess
• ingested foreign body
• peri-anal abscess
• rectal perforation

• acute peritonitis
• descending colon
• intestinal perforation
• laparoscopic treatment
• swallowed foreign body

• blunt trauma
• cecal perforation
• critical care
• swallowed foreign body
• trauma

• bowel perforation
• foreign body ingestion
• laparotomy decision
• small bowel obstruction
• toothpick

Patients with foreign bodies in the digestive tract are often encountered, but complete penetration of a foreign body through the gastrointestinal tract is rare, and the choice of imaging method is very important. Improper selection may lead to missed diagnosis or misdiagnosis.

An 81-year-old man was diagnosed as having a liver malignancy after he took magnetic resonance imaging and positron emission tomography/computed tomography (CT) examinations. The pain improved after the patient accepted gamma knife treatment. However, he was admitted to our hospital 2 mo later due to fever and abdominal pain. This time, he received a contrast-enhanced CT scan, which showed fish-boon-like foreign bodies in the liver with peripheral abscess formation, then he went to the superior hospital for surgery. It lasted for more than 2 mo from the onset of the disease to the surgical treatment. A 43-year-old woman with a 1 mo history of a perianal mass with no obvious pain or discomfort was diagnosed as having an anal fistula with the formation of a local small abscess cavity. Clinical perianal abscess surgery was performed, and fish bone foreign body was found in perianal soft tissue during the operation.

For patients with pain symptoms, the possibility of foreign body perforation should be considered. Magnetic resonance imaging is not comprehensive and that a plain computed tomography scan of the pain area is necessary.

• Acute abdomen
• Bowel perforation
• Liver foreign body
• Buttocks foreign body
• Fish bone
• Case report

Ingesting foreign bodies in the GI tract is not common, especially among adults. Here, we present a case of a 38-year-old male with a hyper-dense linear foreign body perforating the distal ileum, which turned out to be a 5-cm long fish bone eaten about a month before the presenting symptoms.

• endoscopy, digestive system
• esophageal diseases
• foreign bodies

• Animals
• Endoscopy, Gastrointestinal/methods
• Esophageal Mucosa
• Esophageal Perforation/diagnostic imaging
• Esophageal Perforation/etiology
• Esophageal Perforation/surgery
• Female
• Foreign Bodies/complications
• Foreign Bodies/diagnostic imaging
• Foreign Bodies/surgery
• Humans

• Faecal peritonitis
• Fishbone
• Gastrointestinal foreign body
• Ileal perforation

Esophageal foreign body (FB) is a common clinical emergency. Clinically, computed tomography (CT) scans are important in the diagnosis of FBs in the esophagus. Here, we report a case of esophageal perforation and cervical hematoma, caused by a FB, whose uniqueness made rapid diagnosis difficult.

A 42-year-old man was transferred to our hospital with esophageal perforation, which was accompanied by cervical and mediastinal hematoma. CT scans only revealed a black shadow, approximately 2.5 cm in diameter, in the upper esophagus. After multidisciplinary discussion, he was quickly subjected to mediastinal hematoma resection, peripheral nerve compression release, esophageal FB removal and esophagectomy. Eventually, we removed a small crab with a pointed tip from his esophagus.

This was an unusual case of occurrence of sharp polygonal esophageal FBs caused by a small crab. Rapid diagnosis of this FB was difficult, mainly due to its translucent nature. Occurrence of sharp FBs, with cavities that sometimes only appear as black shadows on CT scans, can easily be mistaken for esophageal lumens. More attention should be paid to such sharp polygonal FBs.

• Esophageal foreign body
• Esophageal perforation
• Neck hematoma
• Case report

• Bone impaction
• Detection
• Neck CT
• Neck X-ray

• Adult
• Animals
• Bone and Bones/diagnostic imaging
• Diagnosis, Differential
• Female
• Fishes
• Foreign Bodies/complications
• Foreign Bodies/diagnostic imaging
• Humans
• Male
• Middle Aged
• Neck/diagnostic imaging
• Neck Pain/diagnostic imaging
• Neck Pain/etiology
• Observer Variation
• Radiography/methods
• Radiography/statistics & numerical data
• Sensitivity and Specificity
• Tomography, X-Ray Computed/methods
• Tomography, X-Ray Computed/statistics & numerical data

• Biliary complications
• Common bile duct
• Endoscopy
• Fish bone
• Foreign body
• Papilla of Vater

• children
• fishbone
• intestinal perforation

Fish bone is one of the most common foreign body ingestions encountered in the emergency department. Fish bone perforations occur most commonly in segments with acute angulation like the ileocecal region and rectosigmoid junction and can present acutely with obstruction and free air or with chronic complications like abscess and sepsis. Radiologists should be familiar with the high-risk clinical scenarios, the CT appearance of radiopaque fishbones, and the spectrum of imaging findings related to gastrointestinal (GI) tract so as to direct management and timely referral to GI endoscopists and surgeons.

• Fish foreign body
• computed tomography
• gastrointestinal tract
• injury

1. Investigate the characteristics of adult patients presenting with acute oesophageal soft food bolus obstruction (SFBO) and impacted foreign body (IFB) at two New Zealand district health boards (DHBs). 2. Review current management against international guidelines for SFBO and IFB.

A multicentre retrospective search of the Provation^® endoscopy database identified patients presenting with acute oesophageal obstruction. Utilising electronic patient records, key data points including patient demographics, risk factors, pre-endoscopic medical therapies utilised, diagnostic radiological investigations performed and endoscopic complications were identified. Key timepoints and delays in the patient’s hospital journey from oesophageal obstruction to therapeutic endoscopy were recorded. The probability of failing to undergo therapeutic endoscopy for SFBO within the timeframes advised in clinical guidelines as a result of a delay in referral to the endoscopy service was calculated.

Over a cumulative 10.5-year period of data collection, 227 oesophago-gastro-duodenoscopies were performed: 195 SFBO, 16 IFB, 16 no obstruction identified. Median patient age was 57 (15–95) years. 143 male and 84 female patients. Radiographs were performed in 50.9% of uncomplicated SFBO. Pre-endoscopy medical therapies were administered in 41.4% of the cases. Median time delay from onset of obstruction to therapeutic endoscopy varied: SFBO 19h 0min, complete obstruction 17h 45min, impacted batteries 1h 15min, and presumed sharp objects 6h 0min. Three patients presenting with a soft food bolus obstruction failed to undergo therapeutic endoscopy due to a delay in referral to the endoscopy service, probability 0.034 (95% CI 0.012, 0.095). Two patients died of complications secondary to oesophageal obstruction.

Oesophageal obstruction is a common gastroenterological presentation. At two large centres in New Zealand, patients waited considerably longer than the recommended timeframe from obstruction to therapeutic endoscopy. Contributing factors included patient-related delays to presentation, hospital system-related factors and delays in referral for endoscopy contributed to by unnecessary pre-endoscopic medical therapies and radiographic investigations. Education about oesophageal obstruction together with robust local guidelines have potential to reduce delays and length of hospital stay, as well as reduce patient discomfort and complications.

• foreign body
• impaction
• obstruction
• oesophagus
• soft food bolus

Foreign body (FB) ingestion is a common clinical problem in acute settings. Detecting FBs in the upper digestive tract is challenging. The conventional X-ray is usually the first-line imaging tool to detect FBs. However, its diagnostic performance is inconsistent in the literature. In this study, we performed a systematic review and meta-analysis to determine the diagnostic performance of the conventional X-ray for detecting FBs in the upper digestive tract. We conducted a systematic search of PubMed, Embase, Cochrane Library, Web of Science, and Scopus until 1 August 2020. Prospective or retrospective studies investigating the diagnostic accuracy of conventional X-rays for detecting FBs in the upper digestive tract in patients of all ages were included. The Quality Assessment of Studies of Diagnostic Accuracy-2 tool was used to review the quality of included studies. We used a bivariate random-effects model to calculate diagnostic accuracy parameters. Heterogeneity was assessed using I² statistics. We included 17 studies (n = 4809) in the meta-analysis. Of the 17 studies, most studies were rated as having a high risk of bias. Conventional X-rays had a pooled sensitivity of 0.58 (95% confidence interval [CI] = 0.36–0.77, I² = 98.52) and a pooled specificity of 0.94 (95% CI = 0.87–0.98, I² = 94.49) for detecting FBs in the upper digestive tract. The heterogeneity was considerable. The area under the summary receiver operating characteristic curve was 0.91 (95% CI = 0.88–0.93). Deek’s funnel plot asymmetry test results revealed no significant publication bias (p = 0.41). The overall sensitivity and specificity of conventional X-rays were low and high, respectively, for detecting FBs in the upper digestive tract. Hence, conventional X-rays to exclude patients without upper FBs in the digestive tract are not recommended. Further imaging or endoscopic examinations should be performed for at-risk patients.

• fish bone
• foreign bodies
• plain radiography
• upper digestive tract

The majority of ingested foreign bodies pass through the gastrointestinal tract smoothly, with less than 1% requiring surgery. Fish bone could perforate through the wall of stomach or duodenum and then migrate to other surrounding organs, like the pancreas and liver.

We report herein the case of a 67-year-old male who presented with sustained mild epigastric pain. Abdominal computed tomography revealed a linear, hyperdense, foreign body along the stomach wall and pancreatic neck. We made a final diagnosis of localized inflammation caused by a fish bone penetrating the posterior wall of the gastric antrum and migrating into the neck of the pancreas. Upper gastrointestinal endoscopy was performed firstly, but no foreign body was found. Hence, a laparoscopic surgery was performed. The foreign body was removed safely in one piece and was identified as a 3.2-cm-long fish bone. The patient was discharged from the hospital on the fifth day after surgery without any postoperative complications.

Laparoscopic surgery has proven to be a safe and effective way to remove an ingested fish bone embedded in the pancreas.

• Case report
• Fish bone
• Laparoscopic surgery
• Pancreatic neck

In the adult population, foreign bodies may be accidentally or intentionally ingested or even inserted into a body cavity. The majority of accidentally ingested foreign bodies pass through the alimentary tract without any complications and rarely require intervention. Accidentally ingested foreign bodies are usually fish bones, bones of other animals, and dentures. Oesophageal food impaction is the commonest cause of oesophageal foreign bodies in the Western hemisphere. Intentionally ingested foreign bodies may be organic or inorganic, and often require intervention; these patients have either underlying psychological or mental disease or are involved in illegal activities such as body packing, which involves trafficking narcotics. Imaging plays a crucial role in not only identifying the type, number and location of the foreign body but also in excluding any complications. In this comprehensive pictorial review, we provide an overview of the spectrum of foreign bodies ingested in adults, emphasising the role of various imaging modalities, their limitations and common foreign body mimickers on imaging.

• bezoar
• body packing
• dentures
• fish bone
• food bolus
• foreign body

• Bolus
• Foreign body
• Obstruction
• Oesophageal

• Esophageal
• Foreign body
• Systematic review

Fishbone is the most common esophageal foreign body and tends to migrate after piercing the esophagus to nearby structures. Vascular injury around the esophagus is a serious complication and has a high mortality rate, especially in the case of multiple vascular injuries.

We report an extremely rare case of successive vertebral artery and subclavian artery pseudoaneurysms caused by swallowing a fishbone in a previously healthy 29-year-old female. She was transferred to the emergency department of our hospital because of hemorrhagic shock due to a vertebral artery pseudoaneurysm. We successfully managed the vertebral artery pseudoaneurysm with endovascular stent implantation and the patient’s vital signs as well as hemodynamics once became stable. However, the patient died of the second subclavian artery pseudoaneurysm occurring within a short time, which was thought be related to the obvious displacement of the fishbone in the mediastinum.

Surgery and endovascular stent implantation may be the best choice for treating such complications. Early removal of the fishbone is of great significance in improving the survival of such patients.

• Esophageal fishbone
• Vertebral artery
• Subclavian artery
• Pseudoaneurysm
• Endovascular stent implantation
• Case report

Most patients who ingest fish bones do not develop any complications. The small proportion of patients who do complicate, present with non-specific symptoms. A 64-year-old female patient presented with a 2-month history of abdominal pain. Following clinical evaluation and computed tomography scan of the abdomen, a provisional diagnosis of colon cancer was made. Histology of the resected bowel at hemicolectomy demonstrated a perforation by fish bone with an associated abscess. The case illustrates how fish bone perforation may mislead unsuspecting clinicians and may be misdiagnosed as colonic cancer.

• abscess
• bowel perforation
• colonic malignancy
• computed tomography
• fish bone
• hemicolectomy

• Endoscopic intervention
• Foreign body
• Surgical intervention
• Upper gastrointestinal tract

• Abscess
• Computed tomography
• Fish bone
• Foreign body
• Gastrointestinal perforation

• CT
• Emergency
• Fish bone
• Foreign body
• Gastrointestinal perforation

• Abdomen, Acute/diagnostic imaging
• Abdomen, Acute/etiology
• Animals
• Bone and Bones/diagnostic imaging
• Diagnosis, Differential
• Emergencies
• Fishes
• Foreign Bodies/complications
• Foreign Bodies/diagnostic imaging
• Humans
• Intestinal Obstruction/diagnostic imaging
• Intestinal Obstruction/etiology
• Intestinal Perforation/diagnostic imaging
• Intestinal Perforation/etiology
• Tomography, X-Ray Computed/methods

• cervical lordosis
• esophagus
• foreign body
• lateral neck radiography
• prevertebral thickness

• fish bone
• foreign body
• ileum

• Bone and Bones
• Female
• Humans
• Intestinal Perforation/etiology
• Intestinal Perforation/surgery
• Middle Aged
• Seafood/adverse effects

• Computed tomography
• Diagnosis
• Diagnóstico
• Espina de pescado
• Fishbone
• Gastrointestinal perforation
• Perforación gastrointestinal
• Tomografía computarizada

• Acute appendicitis mimic
• Case report
• Duodenal microperforation
• Fish bone
• Observer error

• foreign body removal
• maxillary Heuwieser
• nasal instrument
• oropharynx

Introduction

Foreign body (FB) ingestion is one of the most common complaints presenting at an emergency department (ED), with fish bone impaction being a frequent cause of presentation. Fish bones might be challenging to identify on routine radiography and ED physicians are often left in a state of uneasiness owing to the fear of complications occurring if the fish bone is not removed.

Objective

This study aimed to establish the factors affecting the radio-opacity of fish bones on X-ray.

Materials and methods

The study involved the top three fish species consumed on Saudi Arabia’s western coast. Fish bones from three specimens of each species were radiographically examined by hand-picking bones from different parts of the fish, with particular attention paid to bones that are difficult to spot. Bones were then arranged beside each other, and radiographs were taken for comparison. Inter-species and intra-species radio-opacity variation was tested. Further, the weight of each fish and method of cooking (baked vs. fried) were tested for their effect on radio-opacity.

Results

No significant difference in radio-opacity was found among and between different species, and the method of cooking did not alter the radio-opacity of fish bones. Significant differences in radio-opacity were noted with the difference in the diameter and size of the fish bones, which tended to be less radio-opaque in smaller-sized fish, regardless of the species.

Conclusion

The exact fish species and method of cooking did not alter the fish bone density on an X-ray. The size of the fish and the size of the fish bone are better predictors of higher fish bone density.

• emergency
• fish
• fish bones
• foreign body
• foreign body impaction
• radio-opacity
• red sea
• x-ray