A 32-year-old Hispanic man comes to the emergency department after an episode of choking in the restaurant. He was drinking and dining with his friends at a local restaurant, when he accidentally choked on a fish bone. He initially felt a sharp painful sensation, but this subsided to a vague discomfort after drinking four glasses of water. He denies having any difficulty in breathing, and only has a slight difficulty in swallowing his saliva. He has a mild discomfort and can still feel the fish bone lodged in the back of his throat. On a quick examination of his upper oropharynx, you do not see any evidence of fishbone. Which of the following is the most appropriate next step in the management of this patient?

Question

A 32-year-old Hispanic man comes to the emergency department after an episode of choking in the restaurant.  He was drinking and dining with his friends at a local restaurant, when he accidentally choked on a fish bone.  He initially felt a sharp painful sensation, but this subsided to a vague discomfort after drinking four glasses of water.  He denies having any difficulty in breathing, and only has a slight difficulty in swallowing his saliva.  He has a mild discomfort and can still feel the fish bone lodged in the back of his throat.  On a quick examination of his upper oropharynx, you do not see any evidence of fishbone.  Which of the following is the most appropriate next step in the management of this patient?

Quizplus · Accepted Answer

Explanation: The patient had an accidental ingestion of a fishbone. Depending on the severity of the obstruction, such patients can have a sudden onset of difficulty or inability to swallow oral secretions. They may also have a feeling or sensation of fullness, discomfort, or painful swallowing (odynophagia). Plain chest radiographs are useful in determining the exact location of the foreign body; however, certain objects, such as toothpicks or a fishbone, may not be easily visualized and can be missed on plain radiographs. Most of the patients with a history of foreign body ingestion are asymptomatic and have a negative radiograph. Such patients do not need any further treatment. In all other symptomatic patients or patients with a history of sharp object ingestion (e.g., fish or chicken bone, toothpicks, needles, or pins), an urgent endoscopy should be performed to remove the foreign body and to prevent esophageal perforation. (Choice A) Foreign bodies should not be allowed to remain in the esophagus for more than 24 hours. Sharp pointed objects (e.g., fishbone, pointed pins, etc.) have a high risk of esophageal perforation and should be removed urgently with endoscopy. (Choice B) Asking the patient to perform a finger sweep of his upper oropharynx is not appropriate. (Choice C) Giving the patient sucralfate or any other agent to move the foreign body further into the stomach is not recommended. Educational Objective: Any sharp object in the esophagus should be removed emergently by flexible endoscopy.

A 32-Year-Old Hispanic Man Comes to the Emergency Department After