# Removal of a Fish Bone Completely Embedded in the Cervical Esophageal Wall

## TL;DR

A rare case of a fish bone completely embedded in the esophageal wall was successfully removed through a cervical incision and intraoperative ultrasound guidance.

## Contribution

This case highlights the effectiveness of intraoperative ultrasound for locating and removing deeply embedded foreign bodies in the esophagus.

## Key findings

- Endoscopic methods failed to locate the fish bone embedded in the esophageal muscle layer.
- Cervical incision combined with intraoperative ultrasound successfully identified and removed the foreign body.
- The case emphasizes the need for multiple removal methods and intraoperative imaging in such rare scenarios.

## Abstract

Fish bone is one of the most frequent foreign bodies in the upper aero-digestive tract. When esophageal foreign bodies penetrate outside the lumen or migrate to the extraluminal region, removal through a neck exploration should be considered. We report a rare case of a 68-year-old woman in whom an ingested fish bone became completely lodged in the cervical esophageal wall. First, an esophagogastroduodenoscopy was performed, followed by a rigid esophagoscopy under general anesthesia; however, no foreign bodies or abnormalities in the esophageal mucosa were found. Endoscopic ultrasound was performed with the assistance of a bivalve pharyngoscope to dilate the entrance to the esophagus, but it was not possible to accurately identify the fish bone that had completely embedded in the esophageal muscle layer. Finally, a cervical incision was made, and the location of the fish bone foreign body was confirmed by directly applying an ultrasound linear probe to the exposed esophageal wall. An incision was then made in the esophageal wall, and the fish bone was removed. Because it is pretty challenging to remove foreign bodies that have completely lodged in the esophageal wall, multiple removal methods should be prepared. We recommend using an intraoperative ultrasound device to identify the location of foreign bodies in the neck.