When a woman in Malaysia accidentally swallowed a fish bone, it soon became a pain in the neck — the bone poked through her throat and became embedded in her neck muscles, according to a new report of the case.
The 54-year-old woman was eating a meal of grilled wolf herring when she experienced "excruciating pain over the throat" along with the sensation that something was stuck there, according to the report, published April 15 in The Journal of Emergency Medicine. She tried to make herself vomit to dislodge the object, but that only made things worse — she began to have difficulty breathing and noticed that her neck was swollen, the report said.
She went to the emergency room, where doctors palpated her neck. They noticed a crackling or popping sound called crepitus, which can occur when air bubbles get into the tissue layer under the skin.
At first, doctors couldn't find the fish bone. They couldn't see it when they visually examined her throat, and it didn't show up on an X-ray. But a CT scan revealed a 2-inch (5.1 centimeters) bone embedded in a large neck muscle known as the sternocleidomastoid muscle, the report said. (Certain types of fish bones show up more easily on X-rays, depending on how much radiation they absorb. Bones from salmon, herring and skate fish let more radiation pass through and so don't show up as well on X-rays, the authors said.)
It's fairly common for emergency room doctors to see patients who swallow fish bones, but usually the bones get stuck in the upper throat and can be easily removed, according to the authors, from Hospital Selayang in Malaysia. Embedded fish bones like the one in this woman's case are uncommon, the authors said. They suspect that rigorous tongue and neck movement helped propel the bone through the lining of her throat, and it then migrated into her neck muscle. As for the woman's crepitus, forceful vomiting can also cause tiny air sacs in the lung to rupture, and the released air can travel along blood vessels into the neck, resulting in air trapped under the skin, also known as subcutaneous emphysema, the authors said.
The woman needed surgery to remove the bone, and she received antibiotics to prevent an infection. After five days in hospital, her symptoms, including her subcutaneous emphysema, had completely gone away, and she was able to go home.
Originally published on Live Science.