What is the treatment for a fish bone stuck in the throat?

From the Guidelines

If you have a fish bone stuck in your throat, seek medical attention immediately, as attempting to remove it yourself can cause further complications, and a computed tomography (CT) scan is likely to be performed to assess the situation, given its high sensitivity and specificity in detecting fish bones and potential complications, as reported in a prospective single-center study 1. When a fish bone is stuck in the throat, it is essential to prioritize medical evaluation over home remedies due to the risk of serious complications such as infection, perforation, or abscess formation.

• Key considerations in the investigation include:
  • Initial evaluation based on patient history and physical examination.
  • Biochemical investigations like complete blood count (CBC), C-reactive protein (CRP), blood gas analysis for base excess, and lactate, as recommended by guidelines 1.
  • Imaging investigations, with plain radiographs (neck, chest, and abdominal) being useful for initial screening but having a high false-negative rate, especially for certain types of foreign bodies like fish bones, which can be as high as 85% 1.
  • Computed Tomography (CT) scan is highly recommended for its high sensitivity (90-100%) and specificity (93.7-100%) in detecting fish bones and assessing potential complications like perforation, abscess, or fistulas 1.
• It is crucial to avoid certain practices, such as:
  • Using contrast swallow, which is not recommended and should not delay other investigations or interventions 1.
  • Oral contrast studies (barium or gastrografin studies) in patients with complete esophageal obstruction, due to the risk of aspiration and impairment of endoscopic visualization 1. Given the potential for serious complications and the importance of accurate diagnosis, medical professionals should prioritize a thorough investigation, likely including a CT scan, to safely manage a fish bone stuck in the throat, as supported by the World Journal of Emergency Surgery guidelines 1.

From the Research

Treatment for Fish Bone Stuck in the Throat

The treatment for a fish bone stuck in the throat can vary depending on the location and severity of the impaction.

• If the fish bone is visible and accessible, it can be removed using direct laryngoscopy or a flexible endoscope 2.
• In some cases, the fish bone may be asymptomatic initially but can cause serious complications such as gastrointestinal tract perforation, obstruction, and abscess formation if it migrates to other parts of the body 3, 4.
• If the fish bone is stuck in the esophagus, a flexible or rigid endoscopic approach can be used to remove it 5.
• Surgery may be required in cases where the fish bone has perforated the esophagus or is endoscopically irretrievable 5.
• Prompt and decisive surgical intervention is crucial to extract the foreign body and avoid severe complications 4.

Diagnostic Approaches

• Radiographs are often negative, but a high degree of clinical suspicion and familiarity with CT appearance can help detect fish bones and associated complications 3.
• A soft tissue lateral neck X-ray can be used to visualize the fish bone 2.
• Site-specific imaging selection is important to guide multidisciplinary management strategies 4.

Management Strategies

• Comprehensive information on the management of fish bone impaction is crucial to avoid severe complications 4.
• Clinical practice guidelines can be developed to address the initial evaluation of the patient, management alternatives, and their advantages and limitations 6.
• A systematic approach to diagnosis and treatment can help reduce the risk of complications and improve patient outcomes 5.