EN 
VN 
CLINICAL CASE SHARING FROM DOCTORS AT BACH MAI HOSPITAL – VIGES MEMBERS
Swallowing fish bones is sometimes underestimated, as most cases pass through the digestive tract without complications. However, a few cases can have serious consequences such as stomach perforation, liver abscess, peritonitis, and even be life-threatening if not diagnosed and treated promptly. Below is a typical report from Bach Mai Hospital that clearly demonstrates the danger of this condition.
1. Typical case
The patient, a 58-year-old male, was admitted to the hospital due to persistent right upper quadrant abdominal pain and fever. Initial clinical examination and imaging revealed a left hepatic abscess. Despite ultrasound-guided abscess drainage and antibiotic treatment, the patient's abdominal pain persisted. A subsequent abdominal CT scan showed a radiopaque, rod-shaped foreign body penetrating from the stomach into the left liver lobe, accompanied by free air in the abdominal cavity. This was identified as a fish bone fragment approximately 2.5 cm long.
The patient was scheduled for emergency surgery. During the operation, the doctors observed a small perforation in the stomach wall anterior to the lesser curvature (approximately 0.5 cm in diameter), with inflammatory adhesions surrounding the stomach and an abscess under the left hepatic capsule. The doctors removed the foreign body, sutured the perforation, cleaned the abdominal cavity, and inserted a drain. Fortunately, the patient recovered well, eating normally after 5 days of antibiotic treatment and post-operative care.
2. Causes and dangerous complications
- The sharp shape of fish bones: Fish bones are thin and pointed, making them very easy to embed and puncture soft tissue. When they move down to the stomach, the bones can get stuck, perforate the stomach wall, and even spread to the liver or nearby organs.
- Easily confused with other digestive disorders: Common symptoms when swallowing fish bones are abdominal pain, fever, nausea, or digestive upset. These symptoms are easily mistaken for stomach ulcers, gastritis, duodenitis, or common infections, leading patients to underestimate the problem.
- Serious complications: When a fish bone punctures the stomach, bacteria and digestive fluids can enter, causing peritonitis. If the bone penetrates deep into the liver, it can lead to liver abscess or sepsis. Without timely intervention, the patient faces the risk of multiple organ failure and septic shock.
3. Prevention and timely treatment methods
- Caution during meals: For fish dishes, remove bones carefully, especially when preparing for young children and the elderly.
- Early medical check-up: If you suspect you have swallowed a fish bone, or experience a sore throat, chest pain, or unusual abdominal pain after a meal, you should go to a medical facility for examination.
- Endoscopic intervention: In many cases, endoscopy helps to identify and remove foreign objects before serious complications occur.
- Emergency surgery: When the digestive tract is perforated or inflammation and abscesses have formed, the last resort is usually surgery to remove the foreign object, suture the perforation, and treat the infection.
4. Conclusion
Complications from fish bone lodged in the stomach can be extremely serious, although the incidence is not high. Initial symptoms are often easily mistaken for other conditions, leading to delays in treatment. The case of the fish bone perforating the stomach and creating a left liver abscess in the patient mentioned above serves as a cautionary tale about the potential dangers in everyday meals. Proactively seeking medical attention if you suspect you have swallowed a fish bone, and adhering to treatment guidelines (endoscopy or surgery), will significantly reduce risks such as peritonitis, liver abscess, sepsis, and even death.
Always be wary of foods with bones, especially fish, to protect your health and that of your family.
