Department of Emergency Medicine, Show Chwan Memorial Hospital, Changhua, Taiwan.
Graduate Institute of Technology Management, National Chung Hsing University, Taichung, Taiwan.
Emerg Radiol. 2021 Jun;28(3):627-631. doi: 10.1007/s10140-020-01891-1. Epub 2021 Jan 27.
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.
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.
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.
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.
鱼骨是成人中最常见的呼吸道异物。大多数鱼骨嵌顿病例在急诊医生使用压舌板进行喉镜检查后，经耳鼻喉科医生行纤维鼻咽喉镜检查前，经初步处理后可自行改善。之后通常会进行计算机断层扫描以确定下一步治疗方案。最近的研究主要关注计算机断层扫描的辐射过量问题。然而，目前仍然缺乏明确的鱼骨摄入管理算法。
回顾性分析了 2017 年 1 月至 2019 年 1 月期间因鱼骨嵌顿就诊于急诊科的 180 例患者。
81.6%的鱼骨嵌顿患者经急诊医生和耳鼻喉科医生的初步处理后症状缓解。在 180 例患者中，有 33 例（18.3%）因持续症状需要行内镜检查。仅有 1 例（0.56%）因穿孔需要手术治疗。在初步处理失败的患者中，8 例患者的颈部侧位 X 线片显示阳性结果，行食管胃十二指肠镜检查取出鱼骨。
对于经初步处理后鱼骨摄入失败的患者，颈部侧位 X 线摄影仍然有益。对于初步处理后症状持续存在的患者，如果没有计算机断层扫描的确认，仅出现阳性的侧位软组织 X 线表现，可能直接提示行食管胃十二指肠镜检查，除非怀疑有并发症。对于年龄在 40 岁以下的患者，在管理后放射检查结果为阴性的情况下进行随访，可能会提高他们的安全性。
