A tiny fish bone caused major medical emergencies in two patients after migrating from the throat into the neck, where it got deeply lodged.  Doctors at Medicover Hospitals, Navi Mumbai, successfully removed the migrated foreign bodies and cautioned the public against delaying treatment or relying on home remedies

A tiny fish bone may seem harmless, but in some cases, it can quickly turn fatal. Fish bone ingestion is one of the most common food-related accidents, especially in regions where fish is a regular part of the diet. There are now concerning cases witnessed by experts wherein people tend to accidentally swallow small bones while eating fish. Many tend to assume that the bone will pass on without any problem, or some may even become anxious and try home remedies. However, if the bone gets lodged deep in the throat or migrates into the surrounding tissues, there can be a higher risk of severe infection and breathing difficulty that can interfere with the individual’s daily routine or may even be life threatening.

In a frightening reminder of these hidden dangers,  two patients (one female and a male) accidentally swallowed fish bones during separate meals and struggled with complications after the sharp bones lodged deep into their neck tissues. What initially was considered just a minor discomfort or an issue by the patients soon led to a medical emergency, as they required timely treatment at Medicover Hospitals.   Their cases serve as a stark warning that even a tiny fish bone should never be ignored.    Not only children, but even adults can also accidentally swallow foodstuffs, such as fish bones, which can land them in trouble.  Everyone must seek help for accidental swallowing of Any Foreign Bodies like fish bones, sapota (chiku) seeds, or fruit pits.

Roma Khanna (name changed), a  53-year-old housewife from Khopoli, accidentally swallowed a fish bone while eating a fish meal during dinner. She experienced symptoms OF   severe throat pain and difficulty in swallowing, which progressed to difficulty in breathing over one week.  Similar to this patient, Naresh Suri (name changed), a 60-year old teacher by profession from Panvel, also presented with foreign body sensation in the throat and severe throat pain following suspected fish bone ingestion 10 days ago.  He accidentally ingested a fish bone while eating his favourite fish meal during lunch. On realising, he tried some popular home remedies like swallowing a bolus of rice and eating a banana. He could still feel the bone being stuck, so he visited a nearby hospital in the evening, from where he was referred to Medicover Hospitals. Such cases can cause distress among patients and can put their lives in danger. These two shocking incidents left the experts worried as they are witnessing a concerning trend of a surge in such incidents. However, timely treatment remains key to patient survival.

Dr. Rajendra Waghela, Consultant ENT & Endoscopic Surgeon, said, “The female patient came in distress, and the initial assessment with Videolaryngoscopy revealed right vallecular and aryepiglottic fold bulge with mild epiglottic edema, but no visible foreign body. The CECT neck demonstrated a linear foreign body deep in the neck above Adam’s apple, consistent with a migrated fish bone with surrounding abscess formation. During evaluation, the patient developed dyspnea and accelerated hypertension. Cardiac assessment revealed a non-ST elevation myocardial infarction with acute decompensated heart failure. Coronary angiography confirmed multivessel coronary artery disease.”

Now, there was a dilemma as the patient had to undergo angioplasty and be started on blood thinners to stabilize the cardiac condition for safe anaesthesia. However, if blood thinners were started, there would be a high risk of bleeding while performing surgery on the neck, making the surgery difficult. So,  a team consisting of  Dr  Rajendra Waghela,  Dr Vishnu Poojari, Radiologist, Dr Tamiruddin Danawade, Cardiologist, and Dr Meghana Choudhary, Anaesthetist, had a multidisciplinary discussion and, after a consensus,  the patient underwent right neck exploration under general anaesthesia with high-risk consent.

The foreign body was initially difficult to localise due to inflammatory, edematous tissue. So, Intraoperative ultrasound was employed with the help of a radiologist to augment the localization of the foreign body. A fish bone embedded in soft tissue near the hyoid bone was successfully removed. The fish bone had become deeply stuck in the soft tissues of the neck, and the surrounding swelling made it very difficult to find during surgery. To locate it accurately, the surgical team used an ultrasound scanner during the operation. This helped them identify the exact live position of the fish bone and remove it safely without causing unnecessary damage to the surrounding tissues. The procedure lasted for an hour.

Dr Tamiruddin Danawade, Cardiologist, said, “Post-operative recovery of this female was uneventful under intensive cardiac monitoring. The patient subsequently underwent angioplasty in stages. First, the blocked artery at the front of the heart (LAD) was treated, followed by angioplasty with the placement of two drug-eluting stents in the right coronary artery (RCA). The patient improved clinically and was discharged in stable condition. This case was challenging as it was clinically high risk, as not exploring would have given rise to airway obstruction. It was risky to give general anaesthesia to a patient with heart failure. This case was a perfect example of the importance of teamwork and a multi disciplinary approach.”

Doctors not only saved the life of this female but also that of another male patient who landed in a similar situation and required timely medical attention.

Dr  Rajendra Waghela explained, “Talking about the second male patient, initial evaluation with videolaryngoscopy under local anaesthesia showed right-sided vallecular and aryepiglottic fold edema with a suspicious site suggestive of foreign body migration. However, no foreign body was directly visualized. Given persistent symptoms such as foreign body sensation in the throat and severe throat pain, and clinical suspicion, further evaluation was done. CT Neck confirmed the presence of a foreign body. The patient underwent right neck exploration under general anaesthesia following appropriate preoperative preparation. Fish bone, being very thin it was not visible initially. So intraoperative ultrasound-guided localization was done, which showed a migrated foreign body in the neck soft tissues from the vallecula to the thyrohyoid membrane. Along with the team that involved Dr Vishnu Poojari, Radiologist, and Dr Josna, Anaesthetist, we removed the foreign body. The patient was discharged when in stable condition.”

BOTH PATIENTS landed up in a life threatening situation because of not seek immediate specialised care after accidental ingestion. Both patients recovered well, and their voices remain unaffected; they have resumed their daily routine with ease. Fish is a dietary staple, and fish bone ingestion is common. Though everyone should remain cautious while having fish with bones and avoid swallowing them.”

Dr  Rajendra Waghela advised that “Persistent throat symptoms or neck swelling with negative endoscopy but a positive fish consumption history should raise suspicion of a migrated or extraluminal foreign body. Persistent fish bone impaction or migration can lead to life-threatening complications like neck abscess, mediastinitis, and airway obstruction. In case of a positive history of fish consumption and an endoscopically non-approachable foreign body, neck exploration should be considered with intraoperative ultrasonography, giving an added advantage of

localization.  Patients should also be cautious and avoid trying home remedies such as opting for sticky and dense foods, such as eating bananas, marshmallow, soft bread soaked in water or milk, bread and peanut butter, palm full of dry rice and drinking water, soda, vinegar solution (vinegar in a cup of water), which are commonly used to get rid of the bone stuck in the throat. Many people also try to dig the bone out with their fingers, tweezers, or other objects,

which can raise the chances of severe injury to the throat. Also, if people feel that the bone is lodged deeply, avoid eating too much food to push it down, as this could cause it to lodge deeper in soft tissues. Don’t ignore symptoms such as inability to breathe or swallow, pain in the throat or chest, spitting up, or coughing blood.  Patients should seek immediate help from the ENT doctor instead of trying anything on their own, as most of the time it can be removed in the clinic itself without any surgery.”

Mr. Neeraj Lal, Regional Director for the Maharashtra and Karnataka Region at Medicover Hospitals, said, “Medical emergencies can also arise from something as common as a fish bone, and can pose a serious threat if not managed promptly. These cases reflect the importance of having experienced specialists, advanced diagnostic facilities, and coordinated emergency care for patients, as every minute matters.”

“The successful management of these complex cases reflects the strength of our multidisciplinary approach, where ENT surgeons, radiologists, cardiologists, anaesthetists, and critical care teams worked seamlessly to deliver the best possible outcome with precision and safety,” concluded  Sandip Joshi, Centre Head, Medicover Hospitals, Navi Mumbai.