Question
Can swallowing fish bones cause permanent damage?
Answer
Yes.
Explanation
The majority of accidentally swallowed fish bones will pass through the gastrointestinal tract uneventfully.
In rare cases, however, complications can occur.
Clinical observations demonstrate some of the following complications from ingested fish bones:
- May be found at the base of the tongue, the vallecula, the pyriform fossa, or deeper in the neck
- May lodge itself in the upper aerodigestive tract, oesophagus, stomach, small bowel, or colon
- May even lodge itself within the trachea or major bronchi
- May perforate the stomach or the duodenum (first section of the small intestine)
- May migrate to the liver, causing an abscess years later
- Can result in hollow viscous perforation (bowel rupturing and leaking)
The most common site is at the level of the tonsils.
Clinical cases are typified by pain (re)occurring several days after ingestion.
Risk is increased by deboning in the mouth rather than on a plate and by using dentures.
Sources
Al-Shukry S.M., A swallowed fishbone penetrating the oesophagus into the sternomastoid muscle, (J Sci Res Med Sci. 2003 Aug;5(1-2):51-2)
Arulanandam, S., et al., A prospective study of epidemiological risk factors for ingestion of fish bones in Singapore, (Singapore Med J 2015;56(6):329-333)
Ede, C., et al., Enterohepatic Migration of Fish Bone Resulting in Liver Abscess, (Case Rep Surg. 2015;2015:238342)
Goh, B.K.P., et al., CT in the Preoperative Diagnosis of Fish Bone Perforation of the Gastrointestinal Tract, (AJR Am J Roentgenol. 2006 Sep;187(3):710-4)
Jha, S.K., et al., Missing fish bone: case report and literature review, (Am J Otolaryngol. 2012 Sep-Oct;33(5):623-6)
Knight, L.C. & Lesser, T.H.J., Fish bones in the throat, (Archives of Emergency Medicine, 1989, 6, 13-16)
Lobeiras, A., et al., Emergency department consultations due to foreign body ingestion, (An Pediatr (Barc). 2017 Apr;86(4):182-187)
Matrella, F., et al., Liver hilar abscesses secondary to gastrointestinal perforation by ingested fish bones: surgical management of two cases, (Hepatobiliary Surg Nutr. 2014 Jun;3(3):156-62)
Santosh, K.S., et al., Management of fish bone impaction in throat – Our experiences in a tertiary care hospital of eastern India, (Egyptian Journal of Ear, Nose, Throat and Allied Sciences, Volume 18, Issue 1, 2017, Pages 27-30)
Sharland M.G., et al., Perforation of the esophagus by a fish bone leading to cardiac tamponade, (The Annals of Thoracic Surgery, Volume 56, Issue 4, 1993)
Symeonidis, D., et al., Ingested fish bone: an unusual mechanism of duodenal perforation and pancreatic trauma, (Case Rep Gastrointest Med. 2012;2012:308510)