Thoracoscopic Removal of a Fish Bone Retained in the Lung for Five Years without the Need for Lung Resection: A Case Report.

INTRODUCTION

The accidental ingestion of fish bones is a common clinical occurrence, especially in regions with high fish consumption. While most foreign bodies pass uneventfully or are removed endoscopically, sharp objects such as fish bones may perforate the gastrointestinal tract and migrate to adjacent organs, occasionally leading to severe complications. Migration into the lung parenchyma is extremely rare.

CASE PRESENTATION: An 80-year-old woman presented with a 5-year history of intermittent hemoptysis following an episode initially diagnosed as bacterial pneumonia. CT revealed a linear hyperdense structure suggestive of a retained fish bone that had penetrated the esophageal wall and migrated into the peripheral left lower lobe. The foreign body had gradually shifted peripherally over time. Video-assisted thoracoscopic surgery (VATS) was performed, and the fish bone, measuring 4 cm, was successfully extracted through a small incision in the lung parenchyma without the need for lobectomy. The postoperative course was uneventful, and follow-up imaging showed resolution of the surrounding inflammation.

CONCLUSIONS

This case highlights an extremely rare instance of a fish bone that remained in the lung for 5 years after esophageal perforation. It underscores the importance of considering retained foreign bodies in the differential diagnosis of unexplained pulmonary symptoms and imaging findings. Furthermore, it demonstrates that even long-standing foreign bodies may be managed effectively with a minimally invasive, lung-preserving approach when preoperative evaluation is carefully conducted.