# Penetrating hypopharyngeal foreign body impalement of the thyroid gland: A case report of rare complication of ingested fish bone

## TL;DR

A 60-year-old woman had a rare complication where a fish bone pierced her thyroid gland after being swallowed, requiring surgery to remove it and highlighting the need for early detection.

## Contribution

First reported case of a fish bone penetrating the thyroid gland after hypopharyngeal perforation.

## Key findings

- A fish bone was found lodged in the left thyroid lobe after hypopharyngeal wall perforation.
- Surgical removal via left hemithyroidectomy was necessary for successful treatment.
- Early recognition and advanced imaging are critical to avoid severe complications like abscess or mediastinitis.

## Abstract

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.

•Extremely rare case of hypopharyngeal perforation by ingested fish bone penetrating into the left thyroid lobe•First reported case of its kind•Required neck exploration and left hemithyroidectomy for foreign body removal•Early recognition is crucial to prevent complications like abscess/mediastinitis.•Advanced imaging and surgical management needed for larger perforations/involvement of surrounding structures

Extremely rare case of hypopharyngeal perforation by ingested fish bone penetrating into the left thyroid lobe

First reported case of its kind

Required neck exploration and left hemithyroidectomy for foreign body removal

Early recognition is crucial to prevent complications like abscess/mediastinitis.

Advanced imaging and surgical management needed for larger perforations/involvement of surrounding structures