Case presentation
Case 1: Migratory fishbone in the retropharyngeal space
A 62-year-old man presented with sudden onset pharyngeal pain after eating fish at a local hospital. Fiberoptic laryngoscopy showed no abnormalities. Computed tomography (CT) revealed a foreign body lying transversely at the right piriform fossa. Painless gastroscopy was performed to remove the foreign body, however, no foreign bodies were detected. During gastroscopy, he presented with laryngeal edema, which required tracheal intubation.
Four days after admission, he was referred to our hospital for management. Cervical CT showed a foreign body in the right retropharyngeal space between the cervical vertebrae 1 and 2 (Fig. 1A and 1B). Subsequently, he underwent surgical exploration of the retropharyngeal space under general anesthesia. During surgery, the foreign body could not be detected in the plane of the second cervical vertebra. An extended longitudinal incision was performed to find the fishbone in the surrounding tissues. Fortunately, a fishbone was found in the plane of the third cervical vertebra. A one-week follow-up revealed the absence of pain and foreign body sensation.
Case 2: Migratory fishbone in the hypopharynx
A 52-year-old man was admitted to our department for throat pain, foreign body sensation, dysphagia, and mild sialorrhea for 3 days after eating fish. Cervical CT confirmed the presence of a linear radiopaque structure in the left laryngopharynx (Fig. 2A and 2B). Flexible fiberoptic laryngoscopy did not identify a foreign body in the area but this revealed the absence of mucosal lesions (Fig. 2C). To further ascertain the presence of a foreign body in the hypopharynx, a gastroscopy was performed showing a fishbone in the left piriform fossa (Fig. 2D). The fishbone pierced from the left piriform fossa into the posterior pharyngeal wall. The object was extracted using forceps. The patient immediately felt comfortable.