Diagnostic and therapeutic challenges of a "minimally invasive penetrating foreign body": a case report.

Missed diagnosis and treatment of esophageal foreign bodies (FBs) carry a risk of severe, life-threatening complications. This case report details the diagnostic and therapeutic management of a 58-year-old woman with a minimally invasive penetrating FB (MIPFB) following fish bone ingestion, who presented with odynophagia. Initial clinical evaluation and electronic nasopharyngolaryngoscopy were unremarkable. A cervical computed tomography scan on day 6 post-ingestion revealed a penetrating FB at the C6 vertebral level. Initial flexible esophagoscopy and a subsequent surgical exploration failed to localize the object. The FB, an approximately 2.5-cm-long fish bone embedded in the right posterior wall of the esophageal inlet, was ultimately and successfully retrieved via a repeated, meticulous endoscopic procedure employing targeted mucosal manipulation. This case highlights that MIPFB cases are prone to diagnostic delay and emphasizes that repeated, careful endoscopy is a superior and less invasive therapeutic strategy compared to surgical exploration in such complex scenarios.