Migration of ingested fish bone and toothpick focusing on comparative clinicoradiological findings and analysis of diagnostic errors: a structured narrative review.

INTRODUCTION

Ingested sharp foreign body (FB) such as fish bones and toothpicks are a relatively rare event, but may migrate to adjacent or distant organs resulting in serious complications and challenging to diagnose. The aim of this paper is to review the literature about the comparative analysis of clincoradiological findings between migratory fish bones and toothpicks and investigated the frequency and associated factors of diagnostic errors.

MATERIALS AND

METHODS

Our review search identified a total of 96 studies with 107 patients containing case reports of ingested migratory fish bones and toothpicks. We then performed a comparative analysis of patients' characteristics, medical history, diagnostics, therapy, and clinical outcome.

RESULTS

Among 107 reported cases, 85 (79.4%) involved migrating fish bones and 22 (20.6%) involved toothpicks. The peritoneal cavity was the most common migration site (69/107; 64.5%). Notably, 57.9% of patients (62/107) did not report FB ingestion on admission, and only ten (9.3%) recalled ingestion after postoperative evaluation. Severe complications were observed in 26.2% of cases (28/107). Diagnostic errors occurred in 15 cases (14.0%), with eight missed by imaging and seven misdiagnosed as inflammatory lesions or tumors. Significant differences were noted between fish bones and toothpicks in location, severe complications, and mean length (all P < 0.05).

CONCLUSIONS

Ingested migratory fish bones or toothpicks are a medical emergency capable of causing significant complications, highlighting their importance as a critical differential diagnosis. The diagnostic strategy should prioritize heightened clinical awareness, a detailed history of FB ingestion, and the use of multiplanar reconstruction CT in conjunction with ultrasound.