Publications
- A Malaysian woman was enjoying a meal when she accidentally swallowed a fish bone
- In the emergency room, doctors found the bone had poked through her throat and became embedded in her neck muscles
- She underwent surgery and reportedly fully recovered
If fish forms part of your diet, you've probably swallowed a fish bone more than once. This is a common occurrence, and the offending bone usually passes through the digestive tract without any issues. On the odd occasion, it may end up getting stuck in the throat – but can usually be removed without too much trouble.
Unfortunately, in one woman’s case, the bone she swallowed ended up penetrating her throat and becoming embedded in her neck muscles.
The case, involving a 54-year-old woman from Malaysia, was reported in The Journal of Emergency Medicine. The woman was eating a meal of grilled wolf herring when she experienced "excruciating pain over the throat", along with a “foreign sensation” indicating that something was stuck there.
She tried multiple times to get rid of the ingested bone, the doctors wrote, but this only worsened her symptoms. After a while, she started to experience difficulty breathing and noticed progressive swelling in her neck.
When the woman eventually went to the emergency room, doctors from Hospital Selayang in Malaysia examined her, but found that she appeared comfortable and spoke with a normal voice.
However, when they palpated her neck they noticed a crackling or grating sound, medically referred to as “crepitus”, which is caused by bones rubbing against each other.
Common in certain regions
Since fish bones are small they can be easily missed while eating, but rapid eating behaviour can also lead to these types of cases, the doctors noted.
According to their report, there is a high incidence of fish bone swallowing in Asia, the Mediterranean, and other coastal countries, due to people eating fish containing bones.
CT scan revealed bone
The doctors couldn’t find anything when they visually examined the patient’s throat, and even when they performed an X-ray examination they couldn't find any “identifiable foreign object”, they explained.
A subsequent computed tomography (CT) scan of the neck, however, revealed a fish bone that had migrated to her neck and became embedded in a large neck muscle, called the sternocleidomastoid muscle.
According to the report, the bone measured 5.1 cm.
The fishbone measured approximately 5cm. Image credit: The Journal of Emergency Medicine
Why the X-ray didn’t pick it up
X-rays are cheaper and produce faster results than CT scans but there are certain types of fish bones that don’t show up easily on X-rays. These include bones from salmon, herring, and skate fish, as they let more radiation through than other bones, the doctors explained. This is why a CT scan should be done, as it “offers cross-sectional imaging as well as higher sensitivity”, they wrote.
Patient undergoes surgery
It’s fairly common for people who swallow fish bones to end up in the ER, the doctors noted, but in most cases, the bones are lodged in the upper throat and can easily be removed.
Impacted fish bones that become embedded in the throat are uncommon and carry the potential risk of life-threatening events, they cautioned.
Unusual complications caused by a migrated fish bone include deep neck abscess and airway obstruction (blockage of the breathing passages). It’s important to note that the way a case is managed is largely influenced by the type of fish bone swallowed, how quickly symptoms progress, and how quickly a patient gets to the ER.
The woman underwent surgery to remove the bone and was given antibiotics to prevent infection. Her symptoms completely disappeared after five days in hospital, after which she was discharged.
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