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Table of Contents
Year : 2003  |  Volume : 5  |  Issue : 1  |  Page : 42-43

No fishbone seen-repeat cervical spine x-ray

1 Associate Professor in Otolaryngology, King Faisal University, Saudi Arabia
2 Consultant ENT Surgeon, Qateef Central Hospital, Saudi Arabia

Date of Web Publication11-Jul-2020

Correspondence Address:
FRCS Ezzat E Dawlatly
King Fahd Hospital of the University, P. O. Box: 40008 Al-Khobar 31952
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1319-8491.289565

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A rare case of a sheep’s metacarpal condyle impacted in the oesophagus is reported. The radiological appearance of a “duplicate seventh cervical vertebra” caused confusion due to an initial poor history of suspected fish bone ingestion. The timely arrival of the patient’s daughter saved the day.

Keywords: foreign body, bone, ingested

How to cite this article:
Dawlatly EE, Bohliga LA. No fishbone seen-repeat cervical spine x-ray. Saudi J Otorhinolaryngol Head Neck Surg 2003;5:42-3

How to cite this URL:
Dawlatly EE, Bohliga LA. No fishbone seen-repeat cervical spine x-ray. Saudi J Otorhinolaryngol Head Neck Surg [serial online] 2003 [cited 2022 Dec 8];5:42-3. Available from: https://www.sjohns.org/text.asp?2003/5/1/42/289565

  Case Report: Top

A 60-year old female was brought in distress to the Emergency Room. She could not talk intelligibly and was drooling saliva. Her gesturing and attempts tospeak gave the impression that she had a fishbone stuck in her throat while eating her lunch half an hour earlier. Throat examination revealed no fishbone, and she was unable to co-operate for mirror examination. A soft tissue X-ray of the neck was ordered. The attending resident saw the film and remarked“no fishbone seen”. He noticed an abnormality in the lower cervical spine and ordered irepeat cervical spinet x-ray [Figure 1]. Before the patient was returned to radiology, her daughter arrived and explained that her mother was eating lamb hooves (trotters) stew and not fish. The patient was hypertensive and diabetic on anti-hypertensive treatment and oral hypoglycaemics respectively. Her blood sugar was 21 mmol/1. Full blood count, chest X-ray and electrocardiogram were within normal. She was taken to the operation theatre where she was intubated with a 5.0 mms uncuffed tube with some difficulty.The metacarpal condyle of a sheep’s hoof was impacted at the level of the cricopharyngeus. It had a jagged irregular upper surface and a sharp smooth articular surface. It was disempacted and removed at the fourth attempt. There was no bleeding. Upper oesophageal endoscopy revealed no mucosal tears. There was no surgical emphysema and post-operative chest x-ray was normal. She was started on sterile water by mouth 12 hours later, and was discharged thenext day in good condition.
Figure 1: Lateral neck x-ray of patient giving the appearance of a duplicate C7

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  Discussion: Top

Impacted foreign bodies in the oesophagus are different in the 2 main age groups reported-children and adults. In adults, fish, chicken and meat bones account for the majority of ingested foreign bodies, while coins top the list of oesophageal foreign bodies in children. In 2 prospective studies of ingestedforeign bodies, fish and meat bone accounted for 64% (159/248) [1], and 68% (200/294) [2] of foreign bodies reported by patients. Jones et al, 1991 [2] removed fish and meat bones from 82/121 (67.7%) patients. They removed meat bone from 18/32 (56%) positive oesophagoscopies. Derowe and Ophir,1994 [3] found fish and meat bone ingestion reported in 63/98 (64%) of their patients. They removed fish and meat bones from 43/76 (56.5%) positive oesophagoscopies. Nearly all their negative oesophagoscopies (20/22) were for suspected fish and meat bone. The 21 coins removed by Derowe and Ophir, 1994 [3] were exclusive to the paediatric population.

Hawkins, 1990 [4] found coins accounted for 81% of 246 blunt foreign bodies removed from children. Crysdale et al [5] report coins in 281/505 (55.5%) paediatric foreign bodies, while bone accounted for only 17/505 (3.3%) foreign bodies removed from children.

Impacted bone in the oesophagus whether fish, chicken or meat bone are usually classified with sharp foreign bodies. Hawkins, 1990 [4], in a study of 246 oesophagoscopies to remove blunt foreign bodies in children, reports no bones among the blunt foreign bodies. Impacted meat bone is almost always a thin sharp piece of bone on its own or with meat attached. A computerised literature search did not show any hoof bone reported. Wecksell et al, 1995 [6] reported an oesophageal perforation in an 85-year-old woman who accidentally swallowed a blister pack containing a tablet. They stress the value of a lateral radiograph of the neck (a safe non-invasive procedure) prior to oesophagoscopy, which usually requires a general anaesthetic. This contrasts with Derowe and Ophir, 1994 [3] report that in suspected bone impaction barium studies and neck x-rays were not helpful in determining the presence of a foreign body.

Trotters stew is a popular dish in the Middle East. Some specialised restaurants in several Arab countries serve just the one dish. The stew is served with rice and/or bread added. The bone impacted in our reported patient gave a radiological shadow the same size as that of the body of the seventh cervical vertebra. Hence the first impression that it may have been a radiological artefact due to failure of a distressed patient to remain still. The timely arrival of the daughter spared her mother further delay. The size of the impacted bone and its jagged sharp margins were puzzling. Attached tendons and articular and epiphyseal cartilage might have given it a smooth contour and contributed to its easy passage. The patient did not wear dentures and her blood sugar was poorly controlled. Phillips and Patel,1988 [1] found no relation between partial or complete dentures and foreign body ingestion. They concluded that foreign body ingestion is the result of either sheer misfortune or sheer carelessness through people bolting their food. The size of the foreign body suggests that the patient consciously took the trotter with the attached tendons in her mouthful. Sheer misfortune or carelessness, as suggested by Phillips and Patel, 1988 [1], was the most likely cause of the mishap.

  References Top

Phillipps JJ, Patel P. Swallowed foreign bodies. J Laryngol Otot 1988; 102: 235-241.  Back to cited text no. 1
Jones NS, Lannigan FJ, Salama NY. Foreign bodies in the throat: a prospective study of 388 cases. J Laryngol Otol 1991;105:104-108.  Back to cited text no. 2
Derowe A.Ophir D. Negative Findings of Esophagoscopy for Suspected Foreign Bodies. Am J Otolaryngol 1994; 15[1]: 41-45.  Back to cited text no. 3
Hawkins DB. Removal of Blunt Foreign Bodies from the Esophagus. Ann Otol Rhinol Laryngol 1990; 99: 935-940.  Back to cited text no. 4
Crysdale WS, Sendi KS,Yoo J. Esophageal Foreign Bodies in Children ñ 15-Year Review of 484 Cases. Ann Otol Rhinol Laryngol 1991; 100: 320-324.  Back to cited text no. 5
Wecksell A, Lane E.Greenfield E. Odynophagia caused by inadvertent blister pack ingestion. Otol Head & Neck Sur 1995; 112 [6]: 747-749  Back to cited text no. 6


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