Usefulness of Plain Radiographs for Management of Suspected Fishbone Impaction in Digestive Tract of Children

Chung, Heajin; Kwak, Young Ho; Kim, Do Kyun; Jung, Jae Yun; Lee, Jin Hee; Kim, Hahn Bom

Abstract

PURPOSE
This study was conducted in order to identify the clinical characteristics of fish bone impaction among children in three tertiary hospitals and to investigate the usefulness of plain radiographs.
METHODS
Children with suspected fish bone impaction in their aerodigestive tract were enrolled in this study. Data on patient's sex and age, characteristics of the allegedly ingested fish bone, utilization rate and result of neck radiographs, and removal procedures were collected retrospectively from three university-affiliated hospitals.
RESULTS
A total of 270 children, from Seoul National University College of Medicine (n=113), Seoul National University Bundang Hospital (n=114), and Seoul National University Boramae Hospital (n=43) were enrolled consecutively. A total of 162 patients (60.0%) were male; the mean age of subjects was 6.9+/-4.1 years. The most commonly suspected source of fish bones was mackerel (n=58, 21.5%), followed by yellow corbina (n=57, 21.1%), and cutlass fish (n=22, 8.2%). Results of initial oropharyngeal inspections by emergency physicians (EP) were negative in 213 patients (78.9%). Among these patients, 173(64.1%) underwent simple neck radiography (radiograph group) and 40(14.8%) patients did not (non-radiograph group). In the radiograph group, no fish bone (0.0%) was observed on plain radiographs. Additional throat examinations were consulted to otolaryngologists (OL), and fish bones were detected in 62(35.8%) and 15(37.5%) patients, from the radiograph group and non-radio group, respectively. Among oropharyngeal inspections performed by EP or OL (130 patients), the most common impacted site of fish bones was the paratonsillar area (n=92, 71.5%).
CONCLUSION
Mackerel and corbina are common sources of fish bone impaction in Korean children. Due to poor visualization and no additional information for use in management, the usefulness of plain radiographs is questionable.