Paediatric fish bone ingestion: a 10-year analysis at a tertiary pediatric hospital

Background: Foreign body ingestion is a common problem in paediatric populations, with the most common culprits being coins or small toys. Fish bone ingestion is much less common in children than in adults. Fish bone impaction may lead to serious complications if untreated and, in children, often represents a diagnostic challenge. We review the presentation, investigation and management of fish bone impaction at an Australian tertiary paediatric hospital. Methods: Hospital records of all children presenting to a single, tertiary paediatric centre over a 10-year period for suspected foreign body impaction were identified and retrospectively reviewed specifically for fish bone impaction. Demographic data, presenting history, observed location, investigations performed and outcomes were assessed. Results: Forty-two children (mean age 6.2±4.0 years, 40.5% female) were identified as presenting with fish bone ingestion, accounting for 8.0% of all foreign body impaction over the 10-year period. Mean time to presentation from time of impaction was 19 hours. Seventeen children had a demonstrable fish bone in situ at time of review: 15 required removal; 1 passed spontaneously; and 1 was regurgitated. Ten fish bones were identified in the oral cavity. Plain X-ray was useful in identifying a fish bone in only 3 of 28 cases where X-ray was performed. No complications were experienced. Conclusions: Fish bones are uncommon foreign bodies ingested by children. Most fish bones were identified within the oral cavity or oropharynx, reinforcing the importance of thorough oral examination. Plain X-rays have limited sensitivity in the diagnosis of an impacted fish bone in children.