Esophageal fish bone impaction: the importance of early diagnosis and treatment to avoid severe complications

Esophageal fish bone impaction (EFBI) is a common rea-son for presentation in the Emergency Department and a frequent indication for urgent esophagogastroduodenosco-py (EGD). Although it is usually effectively diagnosed and treated by EGD, a confirmed diagnosis prior to the endos-copy is rare as blood tests, radiography and direct laryn-goscopy are usually normal. We herein report three cases of EFBI. Two patients had been previously discharged without a correct diagnosis. In one case, the patient had a severe complication that required urgent surgery which could have probably been averted with an early diagnosis. Remark-ably, a cervical computed tomography (CT) scan was key to diagnose the EFBI in one case and a large retroesophageal abscess in another cases, thus guiding their management. Both patients, who underwent an urgent EGD, had a favor-able outcome without the need for hospitalization. There-fore, meticulous anamnesis, adequate imaging and urgent EGD are key to treat patients with EFBI.