Treatment for Wishbone Lodged in the Throat
A wishbone (or any sharp-pointed bone) lodged in the throat requires emergent endoscopy within 6 hours for removal, and if the bone cannot be retrieved endoscopically or has caused perforation, immediate surgical intervention is necessary. 1
Immediate Assessment and Imaging
Believe the patient's complaint—any patient claiming to have a bone stuck in their throat should be taken seriously, as failure to remove it can lead to life-threatening septic complications. 2
Obtain contrast-enhanced CT scan as the key diagnostic examination, particularly if perforation or other complications are suspected. CT esophagography is the imaging of choice for evaluating esophageal foreign bodies and potential perforations. 1
Standard lateral neck radiographs often fail to show the bone, so negative imaging should not be reassuring if clinical suspicion remains high. 2
Endoscopic Management (First-Line)
Emergent endoscopy (within 6 hours) is recommended for all sharp-pointed objects, including wishbones, as they pose high risk for perforation and complications. 1
Flexible fiber-optic laryngoscopy and careful examination of the hypopharynx should be performed to locate the foreign body. 3
The bone must be actively looked for and removed—watchful waiting is not appropriate for sharp foreign bodies. 2
Surgical Indications
Surgery is indicated when: 1
- The foreign body is irretrievable by endoscopy
- The foreign body is located close to vital structures
- Esophageal perforation has occurred
- The patient shows hemodynamic instability
- There is obvious non-contained extravasation of contrast material on imaging
- Systemic signs of severe sepsis are present
Surgical Approach by Location
Cervical Esophagus
Direct repair through a left neck incision along the anterior border of the sternocleidomastoid muscle is the preferred approach. 1
Esophagotomy with foreign body extraction and primary closure is the standard surgical technique. 1
If direct repair is not feasible, external drainage with possible esophagostomy should be performed. 1
Thoracic or Abdominal Esophagus
Operative repair is the treatment of choice for free perforation. 1
The surgical approach should include debridement of non-viable tissue, closure of the defect, buttressing with vascularized tissue, and adequate drainage. 1
Critical Timing Considerations
Surgery must be performed within 24 hours if perforation has occurred—delayed surgical management beyond 24 hours significantly increases morbidity and mortality rates (mortality <10% if treated within 24 hours versus 30% after). 1
Even minor delays can be catastrophic, so immediate action is essential once the diagnosis is established. 1
Common Pitfalls to Avoid
Do not dismiss the complaint as psychogenic or assume the bone has passed simply because imaging is negative. 2, 4
Do not rely solely on radiographs—CT imaging is far superior for detecting bones and complications. 1
Do not delay endoscopy for sharp objects—the 6-hour window is critical to prevent perforation. 1
Do not attempt conservative management with sharp foreign bodies like wishbones, as they will not pass spontaneously and carry high perforation risk. 1, 2
Post-Removal Management
Broad-spectrum antibiotics should be initiated if there is any concern for perforation or contamination. 1
Nutritional support via feeding tube (nasogastric or jejunostomy) may be necessary if repair was required. 1
Close monitoring for complications including mediastinitis, pleural effusion, and sepsis is essential in the first 24-48 hours. 1