Case of internal jugular vein injury in 65-year-old woman because of fishbone ingestion.
A 65-year-old woman presented with a 5-day history of pain and swelling on the left side of her neck. She further reported that she had progressive dysphagia ever since she had eaten a grilled fish. She did not have any past medical or family history and denied any drug or substance abuse. This case describes an internal jugular vein injury caused by ingestion of a fishbone.
On physical examination, the patient had low-grade fever 38°C and mild tachycardia. There neck revealed marked stiffness with an 8 x 8 cm erythematous lesion bulging at the level of the thyroid cartilage, anterior to left sternocleidomastoid muscle. Similarly, contrast CT showed a linear foreign body with horizontal orientation in the superior part of the pharynx, along with 40 x 20 mm collection around it. The left internal jugular vein revealed thrombosis with an air bubble. The distal end of the fishbone could be seen adjacent to the left internal jugular vein.
Treatment plan
The surgeons advised against endoscopic removal because of the high risks associated with the procedure and for better exposure and drainage. Therefore, the treatment of choice was surgical removal of the fishbone with administration of heparin, preoperatively. The fishbone was seem at the level of the thyroid cartilage and thrombosed internal jugular vein, transversely into the hypopharynx. The removed bone measured 4 cm in diameter. The perforation of the pharynx was repaired in two layers. In addition, during the procedure, the abscess cavities were drained and the necrotic tissues were debrided. The samples retrieved during the surgery were sent for culture.
The patient’s recovery period was uneventful. She was put on a liquid diet on the 4th postoperative day. A normal barium esophagram helped evaluate the patient’s postoperative conditions. Doctors advised against an ultrasound evaluation because of the rare nature of intracranial sequelae after unilateral ligation of internal jugular vein. Furthermore, preoperative CT showed patency of contralateral internal jugular vein.
The patient was discharged on the 5th day after the procedure.
References
Internal Jugular Vein Injury by Fishbone Ingestion https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7321512/
