Does plain radiography still have a role in cases of fish bone ingestion in emergency rooms? A retrospective analysis

BACKGROUND: Fish bones are the most common aerodigestive foreign bodies found in adults. Most cases of fish bone impaction improve after primary management by emergency physicians with a mirror laryngoscopy using a tongue depressor, before otolaryngologists perform a fiberoptic nasendoscopy. A computed tomography scan usually follows to determine the next step. Studies have recently been concerned about overdoses of radiation from computed tomography. However, clear algorithms remain unavailable for fish bone ingestion management to date. METHODS: A retrospective review was conducted on 180 patients who visited the emergency department with complaints of fish bone impaction between January 2017 and January 2019. RESULTS: A total of 81.6% of patients with fish bone impaction got symptomatic relief after primary management by emergency physicians and otolaryngologists. Out of 180 patients, 33 (18.3%) needed an endoscopic procedure due to persistent symptoms. Only one (0.56%) required an operation due to perforation. In the group failing primary management, the plain radiography of eight patients showed a positive finding and an esophagogastroscopy was done to remove the fish bones. CONCLUSION: Lateral neck radiography is still beneficial to patients with fish bone ingestion failure from primary management. Positive lateral soft tissue radiography in cases with persistent symptoms post primary management may directly suggest esophagogastroscopy without confirmation from a computed tomography, unless complications are suspected. For patients aged below 40, following up on their conditions after post management radiography shows negative results may increase their safety.