Can Stomach Acid Dissolve a Fishbone?
No, stomach acid cannot reliably dissolve fishbones—they typically pass through the gastrointestinal tract intact or become impacted and cause perforation requiring surgical intervention. 1, 2
Evidence Against Gastric Acid Dissolution
The clinical literature demonstrates that fishbones remain structurally intact despite exposure to gastric acid:
Fishbones routinely perforate the stomach wall without evidence of dissolution, as documented in multiple case reports where intact fishbones measuring 3.7 cm were surgically removed after penetrating through the gastric wall into adjacent organs like the liver. 3
Gastric penetration occurs despite anatomical barriers including the thick stomach wall, wide lumen, and presence of gastric acid, indicating that acid exposure does not meaningfully degrade the bone structure. 2
Most fishbones exit the GI tract spontaneously in their original form—approximately 99% pass through without complication, but when complications occur (1% of cases), they involve intact bones causing mechanical perforation, not partially dissolved fragments. 1, 4
Clinical Implications
The failure of gastric acid to dissolve fishbones has important management consequences:
CT imaging reliably detects intact fishbones with 90-100% sensitivity and 93.7-100% specificity, precisely because they maintain their structural integrity and radiodensity throughout GI transit. 5
Surgical removal yields intact bones in all reported cases requiring intervention, with no documentation of partial dissolution affecting bone structure or reducing perforation risk. 1, 6, 3
Complications arise from mechanical perforation at any level of the GI tract (duodenum, jejunum, sigmoid colon) by structurally intact bones, leading to abscess formation, bowel obstruction, and organ penetration. 4, 6
Common Clinical Pitfall
A critical misconception is that waiting for "natural dissolution" is appropriate management. The evidence shows fishbones either pass intact or cause perforation—there is no intermediate dissolution phase that reduces risk. 1, 2