Sometimes the Simplest Solution Is the Best One: Unconventional Resolution of a Food Impaction

Introduction: Impacted food particles/foreign bodies create urgent but not life-threatening clinical scenarios. Early Gastroenterology consult plays a crucial role in management. Foreign body ingestions are accidental in 95% of cases and are almost always related to the intake of food. The esophagus is the most common site for impaction, though, as in this case, foreign bodies in the base of the tongue have been reported. Case Description/Methods: A 55 year-old female presented to the emergency department stating she felt a bone lodged in her throat while eating a meal of catfish, and felt the bone “stuck in her throat.” In the ED, vital signs were stable, and physical examinations were unremarkable, head/neck CT scan revealed a 1.3 cm hypodensity along the rightward oropharynx, extending into the right lingual tonsil. Foreign body impaction confirmed and the gastroenterology team was consulted. Esophagogastroduodenoscopy revealed a normal esophagus; the stomach and duodenum were normal. There was an approximately 1 cm fish bone lodged in the base of the tongue/distal oropharynx on the right side. Two attempts at removal using cold-biopsy forceps were unsuccessful. After the second attempt, the procedure was paused in order to suction secretions. Then, a third pass with the endoscope revealed the bone fragment was no longer present, it could not be visualized within the scope itself, nor anywhere in the patient’s mouth/GI tract. Inspection of the Yankauer suction device revealed the fish bone had indeed been retrieved and had wedged almost perfectly perpendicularly within its distal aperture, in such a way that it was prevented from being pulled into the attached plastic tubing by the wall suction. Patient recovered from the procedure, regular diet resumed and was discharged the same day. Discussion: In this case, where a catfish bone was lodged at the base of the tongue. This location was proximal to the esophageal inlet, and was poorly conducive to retrieval by endoscopy. However, the offending item turned out to be highly amenable to retrieval via a more low-tech approach, i.e. blind oropharyngeal suctioning. Early and urgent endoscopy should not be delayed (even in the absence of imaging). When necessary, removal should be accomplished within 24 hours, as the risk of complications dramatically increases with time. Finally, as we have seen in this scenario, the classic endoscopic interventional approach attempting to either “push down, retrieve, or morcellate” is not always effective nor necessary.Figure 1.: Top: Fish bone lodged in the base of the tongue. Middle-Bottom: Fish bone was removed with suction device.