Wang Ching-Ping, Jiang San-Ling
Department of Otolaryngology, Taichung Veterans General Hospital, National Yang-Ming University, Taichung, Taiwan.
J Formos Med Assoc. 2009 Feb;108(2):170-2. doi: 10.1016/S0929-6646(09)60048-6.
We encountered a 62-year-old woman with a progressively worsening sore throat and a sharp lump located in her left upper neck, which appeared several hours before admission. After questioning, she underwent rigid esophagoscopy at a local hospital for suspected fish bone impaction but this gave a negative result. Unusual signs caused us to arrange a computed tomography scan, which showed that a foreign body had penetrated the left sternocleidomastoid muscle to the subcutaneous layer, with extensive emphysema in the neck. We extracted the foreign body with a 1-cm horizontal incision of the neck under general anesthesia. The patient returned to a normal diet and was discharged on day 5 of hospitalization without further morbidity. This is another rare case of a migrating foreign body presenting as a neck lump. On reviewing the literature, most cases involving subcutaneously migrating fish bones show development of a neck lump several weeks to months after ingestion, with relatively stable conditions. However, our case showed a neck lump 1 day after ingestion with acute toxic symptoms.
我们接诊了一位62岁的女性，她咽痛症状逐渐加重，左上颈部出现一个硬块，在入院前数小时出现。经询问，她因怀疑有鱼骨嵌顿在当地医院接受了硬质食管镜检查，但结果为阴性。一些不寻常的体征促使我们安排了计算机断层扫描，结果显示有一个异物穿透了左胸锁乳突肌至皮下层，颈部有广泛的皮下气肿。我们在全身麻醉下通过颈部一个1厘米的水平切口取出了异物。患者恢复了正常饮食，住院第5天出院，未出现进一步的并发症。这是另一例罕见的以颈部肿块形式出现的游走性异物病例。查阅文献发现，大多数涉及皮下游走鱼骨的病例在摄入后数周数月出现颈部肿块，病情相对稳定。然而，我们的病例在摄入后1天就出现了颈部肿块并伴有急性中毒症状。
