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Fish bone stuck in the muscles of the neck — a clinical case

Malaysian doctors describe in The Journal of Emergency Medicine an unusual neck injury suffered by a woman who swallowed a fish bone.

Zhenina, 54, experienced an «unbearable sore throat» while eating grilled fish. At the same time, she realized that something was stuck in her throat. To get rid of the foreign body, she tried to induce vomiting, but this made her worse. Her breathing became labored, her neck swollen.

In the emergency department of the hospital, doctors felt the patient's neck and found an unexpected symptom — crepitus, a crunching sound, as if small bubbles were bursting under the skin. This is a sign of subcutaneous emphysema — the presence of air in the soft tissues under the skin.

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Doctors were not immediately able to detect the stuck bone: during the examination and on the x-ray, it remained “invisible”. They note that certain types of fish bones do not absorb X-rays well, making them difficult to find. Computed tomography showed that the bone had penetrated into the sternocleidomastoid muscle (the largest muscle of the anterior-lateral surface of the neck) by about 5 centimeters.

Removing fish bones from the throat and esophagus is a common practice for emergency room physicians, but the case described in The Journal of Emergency Medicine is remarkable in that the bone not only penetrated deep into the soft tissues of the neck, but also contributed to the penetration of air into them. Doctors suggest that the “journey” of the foreign body was facilitated by active movements of the tongue and neck. Attempts to induce vomiting could help air in the tissues, experts suggest.

The woman underwent surgery to remove the bone from the muscles, after five days the symptoms practically disappeared.

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Scientists previously described a case of perforation of the small intestine with a fish bone in the New England Journal of Medicine. It can also be called a rarity, because the probability of damage to the intestine in such cases is less than 1%. Usually, foreign bodies that have reached the intestine pass through it. Most often, fish bones get stuck in the throat.

You can learn more about what to do when swallowing a foreign body from our material.

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