Man dodges death after swallowing fish

Doctors didn't flounder when a young man accidentally swallowed a live fish — blocking his airway and almost choking him to death.

The bizarre mishap occurred when the 22-year-old, on a fishing trip to the Murray River, decided to pucker up and kiss his first catch of the day.

Unimpressed by his romantic advances, the fish wriggled free and slid headfirst down the man's throat, complete with fishing line and hook attached.

Its fins and spines swiftly became hooked in his oesophageal and hypopharyngeal mucosa — defying multiple attempts to pull it out.

What followed was a life-saving medical marathon, involving three hospitals, over 150km of driving and an array of quick-thinking doctors.

In severe respiratory distress, the man was first driven to the hospital in Barham, a country town of 1200 people on the NSW-Victorian border, where an emergency cricothyrotomy was performed.

With some oxygen getting in, but deteriorating fast, he was transferred to a larger regional hospital at Kerang, Victoria, where the only local GP with advanced airway training was called in to perform an orotracheal intubation.

The procedure proved extremely tricky - the now-dead fish was completely obscuring the oropharynx — but a size 4 microlaryngoscopy tube was eventually squeezed past, allowing the patient to be properly ventilated at last.

But this was not the end of his woes: now surgeons at a third hospital, Bendigo, were left with the challenge of getting the dead critter out.

In what is thought to be a unique procedure, they opted to cut off the fish's tail and core out its upper body with a bone rongeur. This "collapsed" the remaining part of the fish, so scissors could be passed down its side to snip the scales and spines that were holding it in place. The leftover carcass was eventually pulled out with forceps.

Dr Laurence Weinberg, who reported the case this week, said to his knowledge it was the only Australian case of airway obstruction caused by a whole live fish. Similar cases from overseas had all proven fatal.

The man developed aspiration pneumonia and sepsis, and spent eight days in hospital, but has since made a complete recovery.

"Considering where this occurred ... it's testament to the outstanding management of essentially a very rare clinical condition," said Dr Weinberg, a consultant anaesthetist at Austin Hospital, who was not directly involved with the care of the patient.

"To be managing a life-threatening airway emergency in any rural community would be very concerning and stressful. Under the circumstances, the emergency management was certainly life saving."

BMJ Case Reports 2013; online.