If someone has swallowed a fish bone, it is usually not a big problem. In most cases, the bone passes through the esophagus into the stomach without complications and is dissolved there. However, in very rare cases, it can become lodged in the esophagus and then cause health problems.
What does a swallowed fish bone mean?
When eating, it sometimes happens that food debris enters the trachea when the laryngeal cover does not close properly during the swallowing process. This results in a coughing impulse to remove the foreign bodies from the trachea again. A completely different situation arises when someone swallows a fish bone. Fish bones belong to the skeleton of bony fish. They are needle-like connective tissue ossifications that have no connection to the fish’s spine. In fish meals, they are often found in the food and can be swallowed unnoticed. However, there are few cases of fish bones entering the trachea. Usually they are transported unnoticed through the esophagus with the food pulp into the stomach. However, fish bones have tips with which they can bore into the mucous membrane of the pharynx or esophagus. However, this happens only in rare cases. Even then, it remains largely undramatic, as the bones dissolve after a certain time due to digestive processes. Only in very rare cases does an emergency occur, which can also be life-threatening.
Causes
If fish bones are not completely removed before eating fish meals, it can sometimes happen that they are swallowed. Especially with larger bites that are not chewed long enough, fish bones are also regularly swallowed. This usually goes unnoticed because the bone is quickly transported through the esophagus within the mash. However, if it comes into contact with the mucous membrane in the pharynx or esophagus, it is quite possible for it to become embedded there. Often the bone then gets stuck and can no longer be transported further. This often leads to mild discomfort with an unpleasant feeling in the throat, which is associated with a constant gag reflex. Within a few hours, the bone often loosens again or is even completely dissolved by digestive processes in the mucous membrane. However, if it remains stuck for a longer period of time, the body tries to remove the foreign body by stimulating the immune system at this point. Inflammatory reactions develop, which damage or even destroy the affected tissue if the bone remains stubbornly stuck. In extreme cases, scars and adhesions form between various organs, which can also allow the bone to migrate throughout the body and create life-threatening emergencies.
Symptoms, complaints and signs
In most cases, there are no symptoms when fish bone is swallowed, even if it bores into the mucous membrane of the esophagus. However, depending on where the bone lodges, unpleasant symptoms such as pain, uncomfortable stinging sensation in the throat with constant retching, or even difficulty breathing may occur. Shortness of breath occurs especially when it becomes lodged in the laryngeal epiglottis. Swelling forms in this area, leading to breathing problems. Even if the bone has already detached, there may still be pain in the esophagus during eating for a few days until the local wound has healed. In some very rare cases, however, complications occur if the fish bone does not detach at all or even migrates in the body. The esophagus, stomach or even the intestine can be punctured. In rare cases, this can result in spitting blood, tarry stools and shortness of breath. Pain when swallowing and general sore throat then occur anyway. As the inflammation progresses, fever may also develop. In one isolated case, abscesses were even found in the liver, which could be traced back to a migrating fish bone. In this case, the fishbone reached the duodenum, became lodged there, and eventually led to adhesions of parts of the peritoneum to the liver and gallbladder.
Diagnosis
If the above-mentioned symptoms occur after a fish meal, a suspected diagnosis of an ingested fish bone can be made very quickly. The exact location of the bone can be determined by laryngoscopy, radiographs, and CT scans.
Complications
A swallowed fish bone leads to complications and further problems only in very few cases. Especially in the case of small fish bones, they are simply transported into the stomach and dissolve there due to the stomach acid. After that, there are no further complaints or complications. In rare cases or in the case of large fish bones, they can get stuck in the esophagus and cause problems. In most cases, the patient experiences a stabbing pain in the esophagus or throat, which can also lead to breathing difficulties or even shortness of breath. The fixation of the fishbone in the larynx is life-threatening, as the affected person can suffocate as a result. In this case, a doctor should be consulted if the patient cannot swallow the fish bone on his own or remove it from the oral cavity. There is usually pain in the larynx and throat for several days after the incident. The fishbone may also puncture the stomach wall, causing bleeding. Inflammation and fever may develop as a result. However, these incidents are very rare. There is usually no treatment. The doctor can remove the fishbone with tweezers so that there is no further discomfort. If the fishbone cannot be reached directly, surgery may be needed.
When should you see a doctor?
If someone swallows a fine fish bone, it is not a reason to consult a doctor. In most cases, self-help measures such as eating a piece of bread or a potato will help. But a larger fishbone that crosses in the throat can lead to unpleasant discomfort. It usually dissolves after eating pieces of potato or bread. It is then digested. A fish bone that is swallowed and stuck in the esophagus can cause retching or coughing, pain and inflammation. In this case, a visit to the doctor should be considered. Symptoms of inflammation are a natural defense reaction of the organism. It recognizes the fish bone as a foreign body. It tries to remove it. If this is not successful, the stuck fish bone can cause open wounds. It could then enter the organism. Sometimes a stuck fish bone causes scarring or adhesions in the surrounding tissue. It can also cause swelling in the esophagus if the condition is unfavorable. If the bone is stuck in the trachea or laryngeal epiglottis, it can cause respiratory distress. Only in very rare cases can the swallowed fish bone cause such severe complications that it causes injury to organs as it travels through the body. Migrating fish bones can cause tarry stools, respiratory distress, or abscesses on organs. Danger to life exists if the swallowed fish bone is lodged in the larynx.
Treatment and therapy
Usually, no special measures need to be taken for a swallowed fish bone. In most cases, it dissolves again on its own and passes into the stomach, where it is then completely digested. Furthermore, the bone can also dissolve in the mucosa of the esophagus due to digestive processes. Sometimes it is possible to dissolve it with some bread and water. If the fish bone is stuck in the upper part of the pharynx, the affected person could remove it himself with tweezers. Only if it is stuck in deeper regions of the esophagus and does not come loose on its own, a doctor should be consulted. The doctor will also first try to remove easily accessible stuck fish bones with tweezers. In rare cases, however, surgery may be necessary.
Outlook and prognosis
If someone swallows a small fish bone, the prognosis is usually good. Small bones are carried on with the food pulp or coughed up. Only rarely are they stuck in the esophagus. If there are visible bones, someone among those present can try to remove the foreign body with tweezers. Sometimes the swallowed bone is stuck deeper in the throat or esophagus. Small sips of undiluted lemon juice can be taken to dissolve them. The citric acid dissolves the fine fishbone. After that, it is easier to pass it with a piece of bread or a boiled potato. A visit to an otolaryngologist is recommended if the coughing irritation does not cause the fishbone to be expelled and all other attempts to remove the fishbone also fail. Swallowed fish bones cannot be visualized by X-ray equipment.In order to switch off the gag reflex and to be able to remove the swallowed fish bone with suitable equipment, the ENT physician performs a spray anesthesia of the throat. Only rarely can ENT physicians neither locate nor remove the stuck bone. Even if the bothersome discomfort eventually subsides, a larger fishbone should always be removed. It can otherwise grow in and cause inflammation. A bone drilled into the esophageal wall is critical. This can lead to infections or, in severe cases, to life-threatening abscesses. If necessary, a mirror examination by a gastrointestinal specialist should be considered.
Prevention
To prevent swallowing a fish bone, fish dishes should be cleaned of bones as much as possible before consumption. Furthermore, prolonged chewing is recommended to feel and remove possible bones before swallowing the food.
Aftercare
In most cases, no follow-up care is needed for a swallowed fish bone because small, completely swallowed bones dissolve in the stomach without consequence. Treatment and follow-up are unnecessary. Follow-up care should only be considered if the swallowed bone has caused damage. For example, if bleeding and swelling occurred, the corresponding area should be examined by a physician. If necessary, an antibiotic is administered after (surgical) removal of the bone to prevent infection. Sprays and medications can be used to help the injuries heal. If surgery was performed to remove a fishbone from the trachea, for example, the surgical scars must be followed up in the same way as other scars. Regular monitoring over a period of a few weeks is appropriate, but not always necessary. If pain or swelling continues to occur at the site where the bone was lodged, an ENT specialist should be consulted for a check-up. If necessary, inflamed or damaged tissue may need to be treated again. It rarely happens that a swallowed fish bone leads to visits to the doctor becoming necessary over a longer period of time. Only deep perforations and inflammation that has occurred can cause this.
This is what you can do yourself
If a fish bone was swallowed, in most cases no measures are necessary. Stomach acid, insofar as the fish bone enters the stomach, will dissolve it and make it digestible. If patients fear the occurrence of rare complications in this connection (perforation of the stomach, etc.), they can actively stimulate the production of gastric acid so that the fish bone is digested better. Ginger, for example, can be eaten for this purpose. The intake of bitter substances also has a positive effect on the production of gastric acid. In addition, the meal should be continued simply, swallowing in small bites. This achieves maximum mixing of the food pulp, which is accompanied by more thorough digestion – and thus better dissolution of the fish bone. If, on the other hand, the bone sits noticeably in the throat after swallowing, it should, after an attempt to cough it up, be conveyed further down by means of ingestion of bread and water. If it is far enough up, it can also be removed with tweezers. In addition, it often helps to wait. People who have swallowed a fish bone and do not show acute symptoms (pain, shortness of breath) but still panic should also be reassured and encouraged to drink water. The same applies to children.
