Wei Hua-Xing, Lv Song-Yong, Xia Bin, Zhang Kai, Pan Chen-Ke
Department of Ultrasound, The Fourth Affiliated Hospital of Zhejiang University College of Medicine, Yiwu 322200, Zhejiang Province, China.
Department of Ultrasound, Jinyun County People's Hospital, Lishui 321400, Zhejiang Province, China.
World J Gastrointest Surg. 2023 Jun 27;15(6):1240-1246. doi: 10.4240/wjgs.v15.i6.1240.
Fishbone migration from the esophagus to the neck is relatively uncommon in clinical practice. Several complications secondary to esophageal perforation after ingestion of a fishbone have been described in the literature. Typically, a fishbone is detected and diagnosed by imaging examination and is usually removed by a neck incision.
Herein, we report a case of a 76-year-old patient with a fishbone in the neck that had migrated from the esophagus and that was in close proximity to the common carotid artery, and the patient experienced dysphagia. An endoscopically-guided neck incision was made over the insertion point in the esophagus, but the surgery failed due to having a blurred image at the insertion site during the operation. After injection of normal saline laterally to the fishbone in the neck under ultrasound guidance, the purulent fluid outflowed to the piriform recess along the sinus tract. With endoscopic guidance, the position of the fish bone was precisely located along the direction of liquid outflow, the sinus tract was separated, and the fish bone was removed. To the best of our knowledge, this is the first case report describing bedside ultrasound-guided water injection positioning combined with endoscopy in the treatment of a cervical esophageal perforation with an abscess.
In conclusion, the fishbone could be located by the water injection method under the guidance of ultrasound and could be accurately located along the outflow direction of the purulent fluid of the sinus by the endoscope and was removed by incising the sinus. This method can be a nonoperative treatment option for foreign body-induced esophageal perforation.
在临床实践中，鱼骨从食管迁移至颈部相对少见。文献中已描述了摄入鱼骨后继发食管穿孔的几种并发症。通常，通过影像学检查检测并诊断鱼骨，且通常通过颈部切口将其取出。
在此，我们报告一例76岁患者，其颈部的鱼骨从食管迁移而来，且紧邻颈总动脉，患者伴有吞咽困难。在食管的插入点上方进行了内镜引导下的颈部切口，但由于手术过程中插入部位图像模糊，手术失败。随后在超声引导下向颈部鱼骨外侧注射生理盐水后，脓性液体沿窦道流入梨状窝。在内镜引导下，沿液体流出方向精确确定鱼骨位置，分离窦道，取出鱼骨。据我们所知，这是首例描述床边超声引导下注水定位联合内镜治疗伴有脓肿的颈段食管穿孔的病例报告。
总之，鱼骨可在超声引导下通过注水法定位，并可通过内镜沿窦道脓性液体流出方向精确确定位置，通过切开窦道将其取出。该方法可为异物所致食管穿孔提供一种非手术治疗选择。
