Life-threatening aortic pseudoaneurysm secondary to fish bone ingestion: A case report

Foreign body ingestion is a common emergency presentation; however, aortic pseudoaneurysm and aortoesophageal fistula (AEF) secondary to fish bone ingestion are exceedingly rare. We report a case of thoracic aortic pseudoaneurysm and AEF caused by a fish bone. A 43-year-old male presented with chest pain one week after ingesting a fish bone. Clinical findings included fever, tachycardia, leukocytosis, elevated C-reactive protein, and anemia. Computed tomography angiography revealed a fish bone adjacent to a 27×17 mm thoracic aortic pseudoaneurysm. Due to hemodynamic instability, emergent zone 2 thoracic endovascular aortic repair (TEVAR) was performed, followed by endoscopic removal of the fish bone, nasogastric tube placement, and mediastinal drainage via mini-thoracotomy. Aortic pseudoaneurysm resulting from fish bone ingestion is life-threatening. TEVAR provides life-saving hemorrhage control in unstable patients, allowing subsequent definitive management.