RUNNING TITLE
AN UNUSUAL FOREIGN BODY: A WHOLE FISH IN THE THROAT
BY
*DUNMADE A.D., *SEGUN-BUSARI S. *OLAJIDE T.G., &
*OLOGE, F.E
*Department of Ear, Nose & Throat,
University of Ilorin Teaching Hospital,
Ilorin, Kwara State, Nigeria.
ALL CORRESPONDENCE TO:
DR. A.D. DUNMADE,
DEPARTMENT OF OTORHINOLARYNGOLOGY,
UNIVERSITY OF ILORIN, ILORIN, NIGERIA.
This paper was presented at the 12th Annual Scientific
Conference of Otorhinolaryngological Society of
Nigeria held in Abuja 2002.
SUMMARY
A wide variety of foreign bodies lodging in the upper aerodigestive tract are
encountered in otolaryngological practice in Nigeria.
Foreign body in the
upper aerodigestive tract is a serious event. The numbers of foreign bodies
that are impacted in the throat are associated with acute symptoms calling for
prompt removal. We describe the case of a 17 years old fisher boy, where a
whole live fish was accidentally impacted in the throat. The patient presented
with severe respiratory difficulty and inability to speak.
complicated with extensive subcutaneous emphysema.
The case was
The patient was
planned for emergency removal. Spontaneous expulsion of the fish occurred
in the Accident and Emergency while the patient is been planned for removal.
To the author’s knowledge this is the first paper that describes the rarity of
this entity in the throat.
Key words: Foreign body, whole fish, Subcutaneous
Emphysema; throat
INTRODUCTION
Impaction of foreign bodies in the throat may be life threatening, especially
the huge ones or the very delicate ones causing symptoms of complications.
It has always been realized that people have swallowed whole kola nuts for
traditional medicinal purpose1.
Some admitted that it is the basis of the
traditional charm, which was supposed to help the swallower get rich quickly.
In the time past, the kobo coin constituted the commonest foreign body
swallowed followed by fish bone1,2. Other foreign bodies include meat, pins,
dentures and toys.
Their complications are sometimes serious and
occasionally fatal. A large number of complications have been reported in
literature. In this paper we present a rare foreign body “A whole fish” in the
throat causing subcutaneous emphysema in a 17 year old professional fisher
boy. What a rare occupational hazard.
CASE REPORT
A 17 year old fisher boy, referred from Federal Medical Center Bida with
history of accidental ingestion of a live fish. The boy was said to have caught
a live fish, holding it between the teeth in an attempt to run after another
fish, the one in the mouth tried to escape into his throat and got stuck there.
There was associated difficulty in breathing, pain in the throat and inability to
speak. On Examination, he was ill looking, in respiratory distress, not able to
talk RR 48/min, not febrile, PR 126/min, good volume oral cavity; shows
drooling of stale blood, with mucopurulent secretion from the throat,
associated poor oral hygiene and the tail of the fish barely visible.
Chest – clear bilaterally but with transmitted sound.
Neck – On palpation shows Subcutaneous emphysema. Patient was admitted
for urgent chest x-ray and X-ray of the soft tissue Neck. The blood was taken
for Full Blood Count and planned for Emergency Tracheostomy and for
removal of the impacted fish via endoscopy. He was managed with IVF,
Tetanus Toxoid, Metronidazole and Unasyn.
We encountered a huge rock of financial constraint the antibiotic and
investigations were not done on time. A side lab PCV of 32% was obtained,
the antibiotic was changed from Unasym to Ampiclox on financial ground.
The respiratory distress was getting worse because of the fast spreading of
the subcutaneous emphysema which was confirmed on x-ray of soft tissue of
the neck (see fig 1a and b). The patient’s relatives absconded after a while
on the pretext of going to look for money for the operation. Spontaneous
expulsion of the fish occurred in the Accident and Emergency while patient is
been planned for surgery. The patient had post expulsion x-ray soft tissue
neck, AP and Lat. Which show extensive subcutaneous emphysema. The
patient however absconded from Admission afterwards.
Discussion
Impaction of swallowed foreign body in the aerodigestive passages will
continue to be a problem for the endoscopist as long as man has to eat to
live1. Foreign body impaction constitutes the commonest otolaryhngological
emergency in Nigeria. There is general agreement that young children are
vulnerable to swallow foreign body2.8,9.
Several reasons have given to
account for this accident; poor children who are not given individual attention
and are left to feed themselves at early age are more vulnerable, children are
very curious naturally10. Coins and fish bones are the most commonly seen
foreign body in the throat amongst the otolaryngologists in Nigeria1,2.
A whole live fish in the throat is a rare occurrence. Our experience shows
that this is rare occupation hazard in this 17 year old fisher boy.
Complications of foreign body in the throat could be serious and occasionally
fatal. Spillage of saliva or food residue into the chest can lead to serious
chest infestions as a result of foreign body in the throat. Lung Abscess and
collapsed Lung as a result of external pressure of an esophageal foreign body
on the main bronchus has been reported2.
Abscesses in the Orodigestive
tract can occur as a result of impaction of fish bone in the throat resulting in
prevertebral, parapharyngeal or retropharyngeal abscess3. Mediastinitis is a
life threatening complication of oesophageal perforation following the
ingestion of foreign bodies 4. Our experience with this case shows a rare
complication of extensive sub-cutaneous emphysema as evidence on soft
tissue Neck x-ray. Multiple perforation by the fin of the fish could have been
the cause for this. Report in literature of similar unusual foreign body in the
throat in a patient who presented with severe respiratory and swallowing
difficulty was seen by Vele-DD; and Dubey-SP5.
Our patient presented
exactly the same manner. Foreign body removal from the throat often times
is an emergency procedure because of the great discomfort it has on the
patient and to prevent unnecessary complication in the neck prevertebreal,
parapharyngeal or retropharngeal abscess are some of the common
complications.
Tracheostomy may sometimes be necessary to relieve
obstruction and to facilitate easy removal in cases of a rare huge foreign
body, which might pose problems to the Anaesthetist. Spontaneous expulsion
is known to occur in cases of foreign body in the throat and nose because of
the cough and sneezing reflex which often occur frequently in most private
otolaryngological practice in an attempt to bargain for the procedural bill with
the child’s parent. Spontaneous expulsion of foreign body in the aerodigestive
passage can either be induced by the patient or patients relative by
attempting to dislodge it by thrusting a finger into the patient’s throat to
induce vomiting1,2,6,7. Our patient expelled the whole fish spontaneously while
the relatives disappeared in an attempt to look for money for the operation.
REFERENCES
1.
Okeowo, PA Foreign Bodies in pharynx and oesophagus – A Ten year
review of patients seen in Lagos.
Nigerian Quarterly Journal of
Hospital Medicine, Vol. 3, No. 2 1985 46-50.
2.
Okafor, BC Foreign Bodies in the Pharynx and Oesophagus, Nig. Med.
J. 9;3; 321-325.
3.
Mastsuki, M; Matswo, M; Kaji, Y; Okada, N
An adult case of
Retropharyngeal cellulitis; diagnosis by magnetic resonance Imaging
Radiat – Med. 1998 July-Aug; 16 (4); 289-91.
4.
Berlot, G; Tomasini, A; Goffi – V; Illicher, C; Semercro, A fatal
streptococcus viridian’s descending, mediastinitis: Case report and
review of the literature, Eur – J –Emerg – Med 1997 Jun; 4(2): 111 - 14.
5.
Vele, DD; Dubey, SP An unusual foreign body: A whole fish in the
throat Auris- Nasus – Larynx. 1997 Apr. 24(2): 207-9.
6.
Okafor, BC Foreign body in the larynx – Clinical features and A plea
for early referral. Nig. Med. J. Vol. 6 No.4 470-72
7.
Yung B; Norton, C; Davies, BH A bronchial butterfly. Eur – Respir-J.
1994 Jan; 7(1). 202-3.