AlTarayra Marwa, Abuzaina Khalil N M, Aljodi Ahmed M I, Fakhouri Sulaiman, Hassouneh Ammar W M
Governmental Hebron Hospital (GHH), Palestine.
General Surgery, Hebron University, Palestine.
Int J Surg Case Rep. 2024 Jul;120:109851. doi: 10.1016/j.ijscr.2024.109851. Epub 2024 Jun 6.
Foreign body ingestion complicated by hypopharyngeal perforation is an uncommon but potentially life-threatening condition. Early recognition and appropriate management are crucial to prevent serious complications. We present an extremely rare case highlighting the importance of this clinical entity.
A 60-year-old female presented with odynophagia 10 days after ingesting fish and chicken. Imaging revealed a linear foreign body penetrating through the left lateral hypopharyngeal wall into the left thyroid lobe, with surrounding inflammatory changes. The patient underwent neck exploration, which identified a sharp fishbone lodged in the postero-medial aspect of the left thyroid lobe, necessitating a left hemithyroidectomy for removal.
To our knowledge, this is the first reported case of hypopharyngeal perforation by an ingested foreign body penetrating the thyroid gland itself. Despite its rarity, early recognition is crucial to prevent complications like abscess, mediastinitis, and mortality. A high index of suspicion is needed in patients with odynophagia or neck pain after ingesting fish. Advanced imaging and surgical intervention may be required for the management of larger perforations or those involving surrounding structures.
This unique case highlights an extremely rare presentation of hypopharyngeal perforation with extension into the thyroid gland caused by an ingested fish bone. Prompt diagnosis through appropriate imaging and treatment with surgical exploration and foreign body removal was key to ensuring a positive outcome. Increased awareness of this potential complication is essential among clinicians.
异物吞食并发下咽穿孔是一种罕见但可能危及生命的情况。早期识别和恰当处理对于预防严重并发症至关重要。我们报告一例极其罕见的病例，以突出这一临床实体的重要性。
一名60岁女性在吞食鱼和鸡肉10天后出现吞咽疼痛。影像学检查显示有一线性异物穿过左侧下咽壁进入左侧甲状腺叶，周围伴有炎症改变。患者接受了颈部探查，发现一根尖锐的鱼骨嵌顿在左侧甲状腺叶的后内侧，因此需要行左侧甲状腺叶切除术以取出异物。
据我们所知，这是首例报道的吞食异物穿透甲状腺本身导致下咽穿孔的病例。尽管这种情况罕见，但早期识别对于预防如脓肿、纵隔炎和死亡等并发症至关重要。对于吞食鱼类后出现吞咽疼痛或颈部疼痛的患者，需要高度怀疑。对于较大的穿孔或涉及周围结构的穿孔，可能需要先进的影像学检查和手术干预来处理。
这一独特病例突出了由吞食鱼骨导致的极其罕见的下咽穿孔并累及甲状腺的表现。通过适当的影像学检查进行及时诊断，并通过手术探查和取出异物进行治疗，是确保取得良好结果的关键。临床医生必须提高对这种潜在并发症的认识。
