Accidental ingestion of a chicken bone often occurs when food is not adequately chewed or when small bones are hidden within meat. While most small or smooth bones pass through the digestive system without incident, ingesting a foreign body carries a risk of complications. A sharp or pointed bone fragment can become lodged or cause injury, meaning the event should not be dismissed, even though serious risks like perforation are rare.
The Bone’s Journey Through the Digestive System
Once swallowed, the chicken bone moves through the pharynx into the esophagus. The esophagus contains three natural narrow points that are common sites for foreign body impaction: the upper esophageal sphincter, the area where the aorta crosses the tube, and the lower esophageal sphincter above the stomach.
If the bone clears these constrictions, it enters the stomach, encountering highly acidic gastric juices. This hydrochloric acid begins the chemical breakdown, partially digesting and softening the bone’s calcium structure. This process helps blunt sharp edges, reducing the risk of trauma as the object moves further down the tract.
After the stomach, the bone fragment is propelled into the small and large intestines by peristalsis. Approximately 80 to 90 percent of ingested foreign objects that reach the stomach will pass naturally and be excreted within a week. Sharp or long objects, such as pointed fragments longer than two inches, pose the greatest danger because they can become lodged or penetrate the intestinal wall, especially at natural bends or areas of narrowing.
Recognizing Warning Signs of a Problem
Immediate Impaction Symptoms
While many swallowed bones cause no symptoms, discomfort arises if the bone causes a minor scratch or becomes impacted. The most immediate sign is acute, persistent difficulty swallowing (dysphagia), often accompanied by a sensation that something is stuck in the throat or chest. The inability to swallow saliva, resulting in excessive drooling, is an urgent sign indicating a complete obstruction of the esophagus.
Signs of Injury or Perforation
Severe, localized, or increasing pain, especially in the neck or chest, suggests the bone has become lodged. Other immediate symptoms include vomiting, gagging, or coughing, which are the body’s attempts to clear the obstruction. If the bone causes an abrasion, the patient may notice blood-tinged saliva or minor bleeding.
Symptoms of a serious complication, such as perforation, may be delayed. If a bone fragment creates a small puncture, it can lead to a slow-developing infection or abscess outside the digestive tract. Signs include fever, chills, or abdominal pain starting hours or days after ingestion. Pain that shifts from the chest to the abdomen, particularly with rigidity or tenderness, may indicate perforation and subsequent infection in the abdominal cavity.
Seeking Medical Help and Treatment
When to Seek Care
Immediate emergency care is necessary for signs of complete obstruction, such as choking, drooling, or severe respiratory distress. For concerning symptoms like persistent pain or difficulty swallowing, seeking medical attention is recommended to locate the object and assess complication risk. Patients must avoid attempts to force the bone down with food or drink, as this increases the risk of pushing a sharp object into the esophageal wall.
Diagnosis and Removal
Diagnosis typically begins with imaging to determine the bone’s location and size. Plain X-rays sometimes miss chicken bones due to their low calcium density. Computed tomography (CT) scans are often utilized as they provide a clearer, cross-sectional view of the object and surrounding soft tissues, helping physicians decide the safest removal method.
The primary method for removing an impacted foreign body is endoscopy, a procedure performed under sedation using a flexible tube with a camera. Endoscopy allows the physician to visualize the bone, assess tissue injury, and remove the object using specialized grasping tools. Urgent endoscopy, performed within a few hours, is required for sharp objects or complete obstructions to minimize perforation risk. If the bone has passed beyond the stomach and is causing intestinal symptoms, observation or, rarely, surgical intervention may be required.