What should I do if I have a fish bone stuck in my neck?

Fish Bone Stuck in Neck: Immediate Management

If you have a fish bone stuck in your neck, seek immediate medical attention at an emergency department for urgent endoscopic evaluation and removal, as this represents a potential surgical emergency that can lead to life-threatening complications including perforation, abscess formation, and vascular injury. 1, 2

Immediate Actions

• Do NOT attempt home remedies such as swallowing rice, bread, or other foods to dislodge the bone—this can worsen the situation by pushing the bone deeper or causing further tissue damage 1
• Go to the emergency department immediately if you experience:
  • Persistent sharp pain in the throat or neck 2, 3
  • Difficulty swallowing or breathing 1
  • Drooling or inability to handle secretions 1
  • Visible neck swelling 3, 4
  • Fever or signs of infection 1, 4

Emergency Department Evaluation

Imaging Studies Required

• CT scan of the neck with contrast is the essential first-line imaging study with 90-100% sensitivity for detecting fish bones and evaluating for complications like perforation or abscess 5, 1
• Plain X-rays have significant limitations with false-negative rates up to 47% for esophageal foreign bodies and should not be relied upon to rule out a fish bone 5
• CT simultaneously identifies the exact location of the bone and any associated soft tissue injury, vascular involvement, or infection 1

Endoscopic Examination

• Emergent endoscopy (within 2-6 hours) is required for sharp-pointed objects like fish bones, especially if causing complete esophageal obstruction 1, 5
• Flexible nasopharyngoscopy and/or esophagogastroduodenoscopy should be performed to visualize and remove the foreign body 2
• Endoscopic evaluation should proceed even if imaging is negative when symptoms persist 5

Surgical Management When Needed

Indications for Surgery

• Immediate surgical exploration is indicated if 1:
  • The fish bone has migrated outside the digestive tract into neck soft tissues 2, 3, 4
  • There is evidence of perforation with extravasation of contrast 1
  • Signs of severe infection or abscess formation develop 1, 4
  • Endoscopic removal fails or is not feasible 1

Surgical Approach

• For cervical esophageal perforations, direct repair should be attempted whenever feasible 1
• If the bone has migrated to neck structures (thyroid gland, prevertebral space, or soft tissues), surgical exploration via anterior cervical approach is required 2, 3, 4, 6
• Intraoperative ultrasonography can help locate migrated fish bones in real-time during neck exploration 3

Critical Complications to Understand

Fish bones that penetrate the mucosa can migrate through tissue planes over days to months, causing 2, 3, 4, 6:

• Thyroid gland penetration (reported cases with bones lodged for 2-9 months) 3, 4, 6
• Vertebral body involvement with migration to cervical spine structures 2
• Abscess formation in neck soft tissues 4, 7
• Major vessel rupture (carotid artery injury) 4
• Skin protrusion in delayed cases (reported at 21 days post-ingestion) 7

Common Pitfalls to Avoid

• Never assume the bone has passed if symptoms persist, even if initial examination is negative 5, 7
• Do not delay imaging with CT if clinical suspicion remains high despite negative X-ray or initial endoscopy 5, 7
• Avoid antibiotics alone without definitive diagnosis and removal—this delays appropriate treatment and allows complications to develop 1
• Recheck the patient if sore throat persists after initial negative findings, as fish bones can be easily missed 7

Follow-Up Requirements

• If the fish bone is successfully removed endoscopically without perforation, close observation for 24-48 hours is warranted 1
• Any patient with confirmed or suspected perforation requires hospital admission for IV antibiotics, NPO status, and surgical consultation 1
• Delayed presentations (>24 hours) have increased morbidity, emphasizing the importance of immediate evaluation 1