Associate Professor, Doctor Huynh Hoang Minh, from the Ear, Nose, and Throat (ENT) Center at Tam Anh General Hospital TP HCM, performed an endoscopy on the patient. The examination revealed a congested throat and swollen hypopharynx. While no fish bone was initially detected in this area, the piriform sinus region showed significant swelling and a small ulcer. A subsequent CT scan identified a mass in the oropharyngeal area, specifically below the right piriform sinus, strongly suggesting a foreign object, likely a fish bone.

Doctors immediately scheduled surgery to drain the piriform sinus abscess and remove the foreign object. A piriform sinus abscess is an infection that results in a collection of pus within the piriform sinus, a small cavity located in the laryngopharynx region, close to the esophageal opening.

CT scan showing the bone at the level of the right piriform sinus. *Photo: Tam Anh General Hospital*

Doctor Minh explained that Mr. Lanh's underlying conditions, including metastatic cancer, chronic kidney failure, and type 2 diabetes, significantly elevated the risk of rapid abscess complications. Timely surgery was crucial to prevent the infection from spreading, compressing the airway, and potentially leading to sepsis.

Associate Professor, Doctor Pham Thi Phuong, also from the ENT Center, performed emergency surgery to drain the abscess. During the procedure, mucopurulent fluid was aspirated from the piriform sinus. The surgical team initially expanded the incision and dissected to the posterior surface of the right thyroid cartilage, entering the piriform sinus, but found no foreign object. It was only after further expanding the surgical field and dissecting deeper into the throat muscle at the level of the thyroid cartilage adjacent to the piriform sinus that the doctors located the foreign object. The removed foreign object was a firm fish bone, 5 cm long, along with a detached fragment from the main bone, measuring approximately 2 cm.

Doctor Phuong (second from right) performing surgery on Mr. Lanh. *Photo: Tam Anh General Hospital*

Following surgery, Mr. Lanh's throat discomfort and pain subsided, and he could eat more easily. Due to his underlying health conditions, doctors closely monitored his recovery. After 7 days, his health steadily improved, and he was discharged from the hospital.

Fish bones are sharp foreign objects that can easily lodge in the throat lining or piriform sinus immediately upon swallowing. The actions of swallowing, pharyngeal muscle contractions, and localized inflammatory responses can cause the foreign object to penetrate the hypopharyngeal wall and migrate into the neck muscles.

If you suspect a fish bone is lodged in your throat, accompanied by symptoms such as a sore throat, painful or difficult swallowing, fever, or persistent neck swelling and pain, it is crucial to seek early diagnosis and treatment from an ENT specialist. Individuals should not attempt to swallow food, like rice, or try to remove the foreign object themselves, as these actions can push the bone deeper and increase the risk of serious complications.

Uyen Trinh

*Patient's name changed