University of South Florida Morsani College of Medicine Tampa, FL, United States
Chanlir Segarra, MD, Keshav Kukreja, MD, John Jacobs, MD University of South Florida Morsani College of Medicine, Tampa, FL
Introduction: Foreign body ingestion is frequently seen in the emergency department (ED). Many times, endoscopic or surgical procedures are required to remove these objects. Here, we present an interesting case of the spontaneous resolution of an ingested, penetrating chicken bone.
Case Description/Methods: A 74-year-old male presented with intermittent sharp, shooting pain in his throat. The pain began the night prior while he was eating chicken wings and felt a bone lodge in his throat. In the ED, vital signs and physical exam were unremarkable. No bones were seen in his oropharynx. X-ray of the neck showed a 2 cm curvilinear opacity anterior to the C5 vertebral body. Subsequent CT-neck revealed a 3 cm hyperdense linear structure at the level of the hyoid bone; intralumenal assessment was difficult to discern, but there was no perforation. GI performed an urgent EGD, which revealed one small, ulcerated penetrating lesion just distal and adjacent to the right piriform sinus, at 16 cm from the incisors. There appeared to be a small opening in the center, concerning for an entry wound from the bone. About 3 cm distally, an extrinsic protrusion was seen in the esophageal lumen, consistent with extrinsic compression from the distal end of the bone. No retained bones were seen in the esophageal lumen. ENT was consulted and performed direct laryngoscopy and rigid esophagoscopy with fluoroscopy, prior to potential open neck exploration. Just prior to this procedure, the patient developed rapid resolution of his throat pain. Thorough evaluation by ENT was unremarkable and, thus, neck exploration was deferred. Repeat CT-neck no longer identified the 3 cm bone. Subsequent barium esophagram was negative for perforation. The patient tolerated a regular diet without pain, remained asymptomatic, and was discharged safely.
Discussion: Cases of bones (fish or chicken) leading to perforation, fistulation, and bleeding have been described (1-2). To our knowledge this is the first case of a penetrating bone which spontaneously resolved by passing through the piriformis, fascial planes, and into the esophageal lumen. We believe that the bone was propelled distally via effortful swallows leading to pharyngeal and esophageal peristaltic contractions.
1. Schlachterman A, et al. Contained esophageal perforation: "Winner, winner, chicken bone dinner". VideoGIE. 2017;2(12):339-341.
2. Zhao S, et al. Sudden Unexpected Death Due to Left Subclavian Artery-esophageal Fistula Caused by Fish Bone. J Forensic Sci. 2019 Nov;64(6):1926-1928.
Figure: Figure 1: A) Initial CT-neck with 3 cm impacted chicken bone at the level of the hyoid bone (red arrow). B) Repeat CT-neck with resolution of impacted bone. C) Entry wound from a penetrating chicken bone at the right piriform sinus (yellow arrow). D) Distal end of the chicken bone protruding back into the esophageal lumen, 3 cm distal to the right piriform sinus.
Chanlir Segarra indicated no relevant financial relationships.
Keshav Kukreja indicated no relevant financial relationships.
John Jacobs indicated no relevant financial relationships.
Chanlir Segarra, MD, Keshav Kukreja, MD, John Jacobs, MD. P2467 - Here Today and Gone Tomorrow: The Case of the Disappearing Chicken Bone, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.