Attention to Fish Bones!

Fish dishes and me

 Eating fish carelessly may lead to a serious 

disease requiring a surgery.

I (Dr. Tokuda) like fish dishes, especially sashimi. And among variety of assortment of sashimi, I like tuna and salmon, a lot. My father is a former fisherman. In Okinawa, fishermen are called ‘Uminchu’ (meaning people of the sea). As a child, I used to eat fish frequently.

However, there are two fish dishes I don’t like. These are one whole fish either broiled or grilled with all its meat and bone. The reason I dislike whole fish when I was young, is to go back to my elementary school days.

One night, the very first catch of my father was our meal for that supper. When I was eating my supper, suddenly, my throat hurt. I spurted out the fish meat from my mouth, and a small fish bone came out.

Since then I have been able to improve the skill of eating a whole fish dish by completely removing fish bone with chopsticks. Since fish dishes served every day in my family, it was considerably a good training for me.

I learned my lesson because I felt intuitively that in every child's heart knows that "I will get harm seriously if I swallow the fish bone, even if I make a mistake accidentally. This is some sort of a protective mechanism inherent in every child.

Fish bones and me

Several years later, I looked up the textbook on fish bones during my medical student 's years at the University of the Ryukyus, and I could no longer find a concrete answer to the question of: “What will happen if I swallow the bones of the fish?"

However, during my residency at Okinawa Chubu Hospital, I was responsible for medical treatment in the Emergency Room. Coincidentally, I came across, once again the "fish bone" I experienced in my elementary school years, and this time a patient at the hospital.

I was in a doctor’s consultation room with a patient with a chief complaint: "My throat hurts suddenly when I was eating fish." I knew right away the diagnosis: fish bone stuck in the throat. The senior resident who had several cases of fish bone showed me how to take out a fish bone stuck in patient’s throat with a use of small scissors-like instrument called "Kansi". The fish bone was taken out and glad to see the patient on the road to recovery and will get well soon without complications.

After that, I was in charge of a male patient with an abscess in the abdominal cavity. The etiology (cause) of abscess was unknown at that moment. The patient complaint of abdominal pain; and had fever. Ultrasound and CT scan examinations were ordered. The initial impression/suspicion before surgical operation, there was a foreign body in the abscess area. Sure enough, the "fish bone" was found during laparotomy surgery. The diagnosis was "fish bone abscess"; length of the fish bone was of several centimeters and was removed together with the abscess. The patient fully recovered after surgical and medical treatment. 

This case was presented at the Medical Society of Okinawa Prefecture around 1990. The presentation was like patterned after Clinical Pathological Conference (CPC). The case which I presented at a formal conference was entitled: “Fish osseous abscess".

Pierced abscess by fish bone

To swallow fish bone is dangerous to the body. 

The first reported case of abdominal disorder due to fish bone in the world was in 1842, with the fish bone penetrating the stomach stuck in the vein of the viscera, resulting in severe phlebitis.

Many of the fishbone diseases reported later are from Asia. The bones of the fish caught in the vicinity of Asia are small and it is "easy to swallow". In the 1980s, Queen Mary Hospital in Hong Kong reported 117 cases of fish bone disease.

"Swallowed" fish bones penetrate like piercing various organs and tissues in the body. When penetrating at the pharynx, cervical abscess or thyroid abscess occurs, and when penetrating through the esophagus, it causes mediastinitis. Penetration through the stomach and duodenum leads to liver abscess and phlebitis of internal organs. The bone of fish

accompanying bacteria in the oral cavity creates pus from the bacteria.

Diagnosis, treatment, and prevention of fish bone abscess diseases

Fish bones do not appear in simple radiographs (x-ray). It is therefore, the diagnosis is surprisingly difficult. Recently, it became possible to diagnose with CT with angle changing part by constructing CT image in three dimensions, which brings about the advancement of diagnosis.

Treatment is surgery. In the future, we may expect laparoscopic surgery. With antibiotics alone, abscess due to "foreign body" cannot be cured.

The most important thing is prevention. As fish cuisine comes out as I do it, standing up, and look carefully like you are in a three-dimension level, and remove the dangerous bones. For elderly people with cataracts and hyperopia, weak eyes, etc. it is better to avoid a “fishy" fish dishes. I would like you to follow my favorite sashimi system, mentioned in the beginning of this article. Because fish dishes are healthy and tasty.

Reference

Gharib SD, Berger DL, Choy G, Huck AE. CASE RECORDS of the MASSACHUSETTS GENERAL HOSPITAL. Case 21-2015. A 37-Year-Old American Man Living in Vietnam, with Fever and Bacteremia. N Engl J Med. 2015 Jul 9; 373(2): 174-83