Esophageal fish bone impaction: the importance of early diagnosis and treatment to avoid severe complications

ABSTRACT

Esophageal fish bone impaction (EFBI) is a common reason for presentation in the Emergency Department and afrequent indication for urgent esophagogastroduodenoscopy (EGD). Although it is usually effectively diagnosed andtreated by EGD, a confirmed diagnosis prior to the endoscopy is rare as blood tests, radiography and direct laryngoscopy are usually normal. We herein report three cases ofEFBI. Two patients had been previously discharged withouta correct diagnosis. In one case, the patient had a severecomplication that required urgent surgery which could haveprobably been averted with an early diagnosis. Remarkably, a cervical computed tomography (CT) scan was key todiagnose the EFBI in one case and a large retroesophagealabscess in another cases, thus guiding their management.Both patients, who underwent an urgent EGD, had a favorable outcome without the need for hospitalization. Therefore, meticulous anamnesis, adequate imaging and urgentEGD are key to treat patients with EFBI. (AU)