Migration of Ingested Fish Bone from Upper Aerodigestive Tract to the Skin of the Neck

Abstract

Introduction
Ingested foreign bodies commonly get impacted in the upper aero digestive tract, but only a few of these foreign bodies have perforated the oesophagus and an even smaller number of these have migrated extraluminally.

Case report
A 43 year old male patient presented with history of accidental ingestion of fish bone (F.B) 3 weeks back. On examination a sharp pointed swelling was seen over right side of neck and on palpation a pointed object was felt beneath the intact skin. Digital X-ray, ultrasonography of the neck and CT scan neck showed a linear obliquely placed foreign body on right side of neck at the level of thyroid gland. The foreign body was easily removed by an incision over the skin and was confirmed to be a fish bone.

Discussion
Horizontally oriented foreign bodies are more likely to penetrate the lumen of a hollow viscus. The muscular contraction of the neck might account for this unusual event to some extent, one possible factor being that the presence of the foreign body in the soft tissue might have led to inflammation and oedema, which made the texture of the surrounding tissue loose and lax ; a sort of gel-sol interconversion.