Fish Bone Ingestion: An Unusual Cause of Traumatic Thyroid Gland Injury

Introduction: Ingestion of foreign bodies, particularly fish bones, resulting in gastrointestinal tract perforations and migration to the adjacent organs are uncommon. We reported two cases of fish bone ingestion leading to oesophageal perforation and migration into a thyroid gland.

Case Report: Case 1: A 51-year-old lady presented with a 5-day history of left anterior neck pain following ingestion of a fish bone. Neck radiography showed a foreign body at the level of C6 - C7. The CT scan revealed a fish bone embedded in the superior pole of left thyroid lobe. Emergency neck exploration discovered a 2 cm long fish bone piercing the oesophagus into the left thyroid lobe. Left hemithyroidectomy with a simple repair of oesophageal perforation performed. Case 2: A 57-year-old lady complained of odynophagia following ingestion of a fish bone. CT scan showed a linear foreign body measuring 23.3 mm located within the right thyroid lobe piecing the strap and sternocleidomastoid muscles. Emergency neck exploration revealed a fish bone protruding from the right thyroid lobe which was subsequently extracted out.

Conclusion: Ingestion of fish bone leading to the oesophageal perforation and migration into a thyroid gland is a rare surgical emergency. Imaging such as plain radiography and computed tomography scan is important for a prompt diagnosis. Computed tomography scan can delineate the precise location of the migrated fish bone to facilitate the surgical exploration. Early surgical intervention by performing neck exploration with either simple extraction of the fish bone or hemithyroidectomy is important for successful outcomes.