Fishing with Magill forceps.

Dear Editor,

A 23-year-old fisherman presented to the emergency room with difficulty in speaking and a foreign body in his throat. The patient was a freshwater fisherman and the technique he employed was to keep a live fish in his mouth and submerge himself under water. The flapping fish would serve to attract other fishes. The fisherman would then proceed to grasp nearby fishes with his hands and throw them out of water. On this occasion, the fish swam further into his mouth and slipped into his throat. Upon examination the patient's vital signs and oxygen saturation were normal. Oral examination revealed no abnormality and the foreign body could not be visualized.

Lateral radiograph of the neck [Figure 1] showed a fish tail bone lodged in the hypopharynx distending the pharynx and compressing the larynx anteriorly. Patient was sedated with ketamine 100 mg intravenously. Upon direct laryngoscopy, a fish tail was seen and the vocal chords were clearly visualized with no obstruction. The fish tail was grasped with Magill forceps and extracted. The patient recovered with no side-effects and was discharged with advice to consider an occupational method change.

Figure 1

Lateral radiograph of the neck demonstrates a fish tail bone lodged in the hypopharynx distending the pharynx and compressing the larynx anteriorly

Upper airway foreign bodies in adults are usually food particles, pills and dental prosthetics.[12] When there is pharyngeal foreign body symptoms vary with the degree of obstruction. Dysphonia, dysphagia and some respiratory distress are present.[13] Patients can be subjected to radiography as long as oxygenation is being maintained and there is no airway emergency. There have been a number of reports demonstrating Magill forceps use in extraction of foreign bodies mainly in children.[456] Direct laryngoscopy and extraction with Magill forceps can be life-saving in pre-hospitals cenarios and rural under equipped centers.[236] In experienced hands, Magill forceps can be a useful instrument as our case demonstrates.