Published online Jun 27, 2023. doi: 10.4240/wjgs.v15.i6.1240
Peer-review started: February 27, 2023
First decision: March 10, 2023
Revised: March 21, 2023
Accepted: April 17, 2023
Article in press: April 17, 2023
Published online: June 27, 2023
Processing time: 108 Days and 4.2 Hours
Fishbone migration from the esophagus to the neck is relatively uncommon in clinical practice. Several complications secondary to esophageal perforation after ingestion of a fishbone have been described in the literature. Typically, a fishbone is detected and diagnosed by imaging examination and is usually removed by a neck incision.
Herein, we report a case of a 76-year-old patient with a fishbone in the neck that had migrated from the esophagus and that was in close proximity to the common carotid artery, and the patient experienced dysphagia. An endoscopically-guided neck incision was made over the insertion point in the esophagus, but the surgery failed due to having a blurred image at the insertion site during the operation. After injection of normal saline laterally to the fishbone in the neck under ultrasound guidance, the purulent fluid outflowed to the piriform recess along the sinus tract. With endoscopic guidance, the position of the fish bone was precisely located along the direction of liquid outflow, the sinus tract was separated, and the fish bone was removed. To the best of our knowledge, this is the first case report describing bedside ultrasound-guided water injection positioning combined with endoscopy in the treatment of a cervical esophageal perforation with an abscess.
In conclusion, the fishbone could be located by the water injection method under the guidance of ultrasound and could be accurately located along the outflow direction of the purulent fluid of the sinus by the endoscope and was removed by incising the sinus. This method can be a nonoperative treatment option for foreign body-induced esophageal perforation.
Core Tip: Fishbones are very common foreign bodies in upper gastrointestinal tracts in clinical practice. The most common fishbone stuck sites are the oropharynx, oral cavity, and esophagus. However, they are movable under the action of esophageal peristalsis, food swallowing and normal pleural pressure, which may cause severe complications if not treated in time. Under the guidance of ultrasound, the fishbone can be accurately located under the endoscope, and the fishbone can be removed by incising the sinus. This method can be an optimal alternative for treating patients with esophageal perforation and reducing surgical trauma.