Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea.
Medicine (Baltimore). 2022 Jul 29;101(30):e29399. doi: 10.1097/MD.0000000000029399.
Among the plethora of foreign body impactions, fish bones are common examples that patients may struggle to properly disclose in clinical situations. This study investigated whether patients could pinpoint where the ingested fish bone was lodged. In addition, we investigated the differences between fish bone and other foreign bodies, the usefulness of computed tomography (CT), and the related risk factors for hospitalization. The cases of patients who underwent an endoscopic removal of fish bone between April 2008 and April 2020 were retrospectively reviewed. The clinical outcomes, X-ray scan, CT, and complications of each patient were investigated. A total of 96 patients were included in this study. The mean size of the impacted fish bone was 23.78 mm, and most were found in the upper esophagus (n = 38). There was a weak correlation between pain location and the actual lesion location (r = 0.419, P < .001). Compared to those of other foreign bodies, the location of impacted fish bones was different (P < .001), the X-ray detection rate of fish bones was lower (P < .001), and the complication incidence was higher (P = .030). CT (95.89%) showed higher sensitivity than X-ray scanning (11.24%) (P < .001). Foreign body size (P = .004) and door-to-endoscopy time (P = .029) were related to admission. Patients only managed to point out the approximate location of the ingested fish bone. CT detected fish bones well, but scans should include at least the entire esophagus instead of solely the area where pain is felt. Fish bone impaction has different clinical characteristics from other foreign bodies. Endoscopic removal without delay can reduce the admission rates.
在众多的异物嵌顿中，鱼刺是患者在临床情况下难以正确透露的常见例子。本研究旨在探讨患者是否能够指出摄入的鱼刺所在位置。此外，我们还研究了鱼刺与其他异物的区别、计算机断层扫描（CT）的作用以及住院的相关危险因素。回顾性分析了 2008 年 4 月至 2020 年 4 月期间接受内镜下鱼刺取出术的患者病例。调查了每位患者的临床结果、X 射线扫描、CT 及并发症。本研究共纳入 96 例患者。嵌顿鱼刺的平均大小为 23.78mm，大多数位于食管上段（n = 38）。疼痛位置与实际病变位置之间的相关性较弱（r = 0.419，P <.001）。与其他异物相比，嵌顿鱼刺的位置不同（P <.001），X 射线检出率较低（P <.001），并发症发生率较高（P =.030）。CT（95.89%）的敏感性高于 X 射线扫描（11.24%）（P <.001）。异物大小（P =.004）和从就诊到内镜检查的时间（P =.029）与住院有关。患者只能指出摄入鱼刺的大致位置。CT 能很好地检测鱼刺，但扫描应至少包括整个食管，而不仅仅是感觉到疼痛的区域。鱼刺嵌顿与其他异物的临床特征不同。及时进行内镜下取出术可降低住院率。
