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Case 121: 'I have a chicken bone stuck in my throat'

After eating a chicken sandwich, this man presents with odynophagia and almost complete dysphagia, spitting up his saliva.

1. Can you see the abnormality?

There is a calcified structure in the cervical oesophagus causing obstruction with dilatation above it and gas in the lumen of the oesophagus. Well, there is gas shadowing on the film, this could represent gas locules outside the oesophageal lumen, indicating perforation.

2. What are the options for treatment?

This requires urgent removal. The gas is presumed to be in the lumen, but the bone could have eroded already and the gas seen on the xray could represent retropharyngeal sepsis. This complication is a potentially life threatening emergency. The distinction between perforation or not could be made more clear by clinical examination and CT scanning of the neck. However, the treatment is similar. The foreign body needs to be removed and the upper aerodigestive tract examined for full thickness injury.

See this case report for a discussion of foreign body ingestion