What should I do if I have swallowed a fish bone?

Management of Swallowed Fish Bone

If you have swallowed a fish bone, seek medical attention immediately if you experience persistent symptoms such as throat pain, difficulty swallowing, or sensation of something stuck in your throat, as fish bones can cause serious complications including perforation of the esophagus. 1

Initial Assessment and Management

Immediate Steps

• If you can still feel the fish bone stuck in your throat:
  • Do not attempt to dislodge it by drinking water or eating food
  • Do not attempt abdominal or chest thrusts as these are ineffective for removing fish bones 1
  • Do not attempt to remove it yourself as this may push it deeper or cause injury

When to Seek Medical Care

• Seek immediate medical attention if you experience:
  • Inability to swallow saliva
  • Severe pain in throat or chest
  • Drooling
  • Vomiting
  • Choking or difficulty breathing
  • Neck tenderness or swelling 1

Medical Evaluation

Diagnostic Approach

1. Clinical evaluation - History of fish bone ingestion and symptoms
2. Imaging studies:
   • Plain radiographs (neck, chest, abdomen) are typically performed first but have a high false-negative rate (up to 85% for fish bones) 1, 2
   • CT scan is recommended if:
     • Plain radiographs are negative but symptoms persist
     • There is suspicion of complications
     • CT has 90-100% sensitivity for detecting fish bones compared to only 32% for plain radiographs 1, 2, 3

Treatment Options

• Endoscopic removal is the first-line treatment for persistent esophageal foreign bodies 1
  • Emergency endoscopy (within 2-6 hours) is recommended for sharp objects like fish bones due to high risk of perforation (up to 35%) 1
  • Most procedures require anesthesia with endotracheal intubation to protect the airway

Potential Complications

Fish bones can cause serious complications if not properly managed:

• Esophageal perforation
• Mediastinal abscess 4
• Cardiac tamponade (rare but life-threatening) 5
• Migration of the fish bone into surrounding tissues 6

Important Considerations

• 80-90% of ingested foreign bodies pass spontaneously through the gastrointestinal tract 1
• Fish bones commonly become impacted at anatomical narrowings:
  • Cricopharyngeus muscle
  • Aortic arch level
  • Transition zone between striated and smooth muscle fibers 1
• Patients may be unaware of having ingested a fish bone and present with nonspecific symptoms 7

Prevention

• When eating fish:
  • Eat slowly and chew carefully
  • Be particularly cautious with fish known to have numerous small bones
  • Consider removing bones before cooking when possible

Remember that prompt medical attention is crucial if you suspect a fish bone is stuck in your throat, as early intervention can prevent serious complications.