Case presentation
Case 1: Migratory fishbone in the
retropharyngeal space
A 62-year-old man presented with sudden onset pharyngeal pain after
eating fish at a local hospital. Fiberoptic laryngoscopy showed no
abnormalities. Computed tomography (CT) revealed a foreign body lying
transversely at the right piriform fossa. Painless gastroscopy was
performed to remove the foreign body, however, no foreign bodies were
detected. During gastroscopy, he presented with laryngeal edema, which
required tracheal intubation.
Four days after admission, he was
referred to our hospital for management. Cervical CT showed a foreign
body in the right retropharyngeal space between the cervical vertebrae 1
and 2 (Fig. 1A and 1B). Subsequently, he underwent surgical exploration
of the retropharyngeal space under general anesthesia. During surgery,
the foreign body could not be detected in the plane of the second
cervical vertebra. An extended longitudinal incision was performed to
find the fishbone in the surrounding tissues. Fortunately, a fishbone
was found in the plane of the third cervical vertebra. A one-week
follow-up revealed the absence of pain and foreign body sensation.
Case 2: Migratory fishbone in the hypopharynx
A 52-year-old man was admitted to our department for throat pain,
foreign body sensation, dysphagia, and mild sialorrhea for 3 days after
eating fish. Cervical CT confirmed the presence of a linear radiopaque
structure in the left laryngopharynx (Fig. 2A and 2B). Flexible
fiberoptic laryngoscopy did not identify a foreign body in the area but
this revealed the absence of mucosal lesions (Fig. 2C). To further
ascertain the presence of a foreign body in the hypopharynx, a
gastroscopy was performed showing a fishbone in the left piriform fossa
(Fig. 2D). The fishbone pierced from the left piriform fossa into the
posterior pharyngeal wall. The object was extracted using forceps. The
patient immediately felt comfortable.