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Swallowed large fish bone. No discomfort or pain in throat. Should I consult a doctor?

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My 3 year old son was eating fish and temporarily gagged on a large fishbone, and continued pointing at the XXXXXXX XXXXXXX to show us where it was caught - not inside his mouth. He salivated continually and gagged intermittently for about 20 minutes before I attempted to drive to the ER, about a five minute drive. Halfway there he began to calm down and then all symptoms disappeared. He told me he had swallowed it, and has been able to eat and drink without visible difficulty or discomfort. He doesn't exhibit any signs of discomfort or pain on throat or abdomen, even when pressure is applied by hand. He doesn't exhibit any irregularities in his breathing. He gagged twice on the car ride, swallowing each time afterwards before the symptoms disappeared, so I strongly believe it isn't in his lungs. This all happened about 3 hours ago. Is there further risk of damaging the digestive tract if the bone isn't extracted, or is it safe to watch him closely at home for a day or two and take him if any further symptoms surface?
Posted Wed, 13 Feb 2013 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 43 minutes later

Thank you for your query.

1. Get X-rays of the neck, chest and abdomen done. A large fish bone should be visible.

2. Fish bones usually get stuck in the tonsil or the posterior third of the tongue. The narrowest part of the gut is the cricopharynx (just behind the adam's apple). Once a foreign body crosses this narrowest portion it usually passes through the entire gut. (The next narrowest part is near the appendix).

3. It is not possible to examine a child by a videolaryngoscopy without general anesthesia. Hence the decision should be made after the x-rays and as you have correctly mentioned, the symptoms. If in doubt, an examination under general anesthesia will settle the issue. An esophagoscopy and a bronchoscopy may also be performed at the same time.

4. It is highly unlikely that a swallowed fish bone will cause any further damage to the digestive tract. However he must be observed for a couple of days at home if you feel it was very large or if it shoes up on an X-ray.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

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