Fish bones may lodge in the tonsil or tongue base.
The patient complains of pain on swallowing and points to the suprahyoid region. The bone may only be obvious on palpation: X-rays are unhelpful.
Removal under direct vision.
A bone or food bolus usually gets lodged at one of four sites:
- One piriform fossa
- The postcricoid region (15cm from the upper incisor)
- The level of the aortic arch (at 25cm)
- At the oesophago-gastric junction (40cm)
Dysphagia may be total, the patient spitting out saliva and pointing to the suprasternal or retrosternal region. A soft tissue lateral X-ray of the neck may delineate a bone.
Endoscopic removal should be undertaken as soon as possible, to avoid airway oedema, soft tissue infection or oesophageal perforation.
Often a peanut in a young child.
After an initial coughing fit there is often a latent period before respiratory distress becomes obvious. The chest X-ray may show collapse of the lung distally, if the obstruction is complete, or emphysema of the involved side if the obstruction acts as a one-way valve.
Bronchoscopic removal is mandatory.