Is Eating Fish a Health Hazard?

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Image Source: The New England Journal of Medicine©

Certainly not!

But accidental ingestion of fishbone can have complications!

The chances of a fishbone being a health hazard are quite thin. It is rare to see a fishbone perforating the walls of the digestive tract in otherwise healthy individuals.

More than 90% of the ingested foreign bodies that reach the stomach pass through, without eliciting any symptoms or without causing impaction. However, around 1% of the patients require surgery for managing gastrointestinal perforation secondary to an ingested foreign body. Endoscopic removal is required in another 10–20% of the patients.

Fishbone bowel perforation is most commonly seen in the ileocecal and rectosigmoid regions.

One such rare case was reported when a 73-year-old man presented to the emergency department with complaints of severe lower abdominal pain, which started abruptly. The patient could not recall any precipitating event on the day of presentation; however, he recalled eating yellowtail fish one day before his presentation to the ED.

On examination, his vitals showed a normal blood pressure of 122/69 mm Hg, a heart rate of 77 beats per minute, and a body temperature of 100.4°F (38°C). Abdominal examination revealed tenderness across the lower abdomen with rebound tenderness.

A complete blood count result showed an increased white cell count of 10,300/ mm3 (reference range, 3300 to 8600) with 83% neutrophils.

Perforation was suspected. Since computed tomography is the method of choice for identifying ingested FBs, an abdominal CT scan was performed. It revealed a linear, high-density body penetrating the small intestine. The thickened gut wall was seen on the scan too. (Panel A).

Surgical exploration via laparotomy was performed. A 2 cm long fishbone was recovered, which had resulted in the perforation of the small bowel (Panel B). The affected portion of the small intestine was resected. The patient was given antibiotics.

Both the intra- and postoperative periods were uneventful, and the patient was discharged 8 days after the surgery.

References

Alex M Almoudaris, A. C. (2011, December). Fish Bone Perforation Mimicking Acute Appendicitis. Journal of Medical Cases, 2, 296-299. Retrieved from Journal of Medical cases: https://www.journalmc.org/index.php/JMC/article/view/151/246

Takafumi Taguchi, M. P. (2019, August 22). Fish Bone Perforation. Retrieved from The New England Journal of Medicine: https://www.nejm.org/doi/full/10.1056/NEJMicm1900442

Choi, Y., Kim, G., Shim, C., Kim, D., & Kim, D. (2014). Peritonitis with small bowel perforation caused by a fishbone in a healthy patient. World journal of gastroenterology, 20(6), 1626–1629. https://doi.org/10.3748/wjg.v20.i6.1626

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Dr. Arsia Parekh
Dr. Arsia Hanif has been a meritorious Healthcare professional with a proven track record throughout her academic life securing first position in her MCAT examination and then, in 2017, she successfully completed her Bachelors of Medicine and Surgery from Dow University of Health Sciences. She has had the opportunity to apply her theoretical knowledge to the real-life scenarios, as a House Officer (HO) serving at Civil Hospital. Whilst working at the Civil Hospital, she discovered that nothing satisfies her more than helping other humans in need and since then has made a commitment to implement her expertise in the field of medicine to cure the sick and regain the state of health and well-being. Being a Doctor is exactly what you’d think it’s like. She is the colleague at work that everyone wants to know but nobody wants to be. If you want to get something done, you approach her – everyone knows that! She is currently studying with Medical Council of Canada and aspires to be a leading Neurologist someday. Alongside, she has taken up medical writing to exercise her skills of delivering comprehensible version of the otherwise difficult medical literature. Her breaks comprise either of swimming, volunteering services at a Medical Camp or spending time with family.

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