MUMBAI: A dinner treat turned into a misadventure for Kurla's Shaikh family. On Feb 3, Ruby Shaikh (name changed), a 34-year-old mother juggling a seven-year-old daughter, a six-month-old son, and four in-laws, was enjoying a rare treat—chicken biryani from a local restaurant. Little did she know that a chicken bone would take her on a month-long medical journey that would perplex even doctors.
The modestly priced biryani left Ruby's husband, a supervisor in a local factory, with an Rs 8 lakh bill, although the hospital later halved it through donations. The 3.2cm chicken bone that damaged Ruby's oesophagus was extracted on Feb 8. But when doctors at Criticare Asia Hospital began the throat procedure, it vanished from its initial position (C4-C5 vertebral discs). X-ray and ultrasound examinations couldn't find it in the chest or abdomen. A CT scan, performed while the patient was intubated, revealed its unexpected upward movement to the nasopharynx, the topmost part of the throat.
The operation lasted eight hours instead of two.
Immediately after choking on Feb 3, Ruby arrived at Criticare Hospital where an X-ray scan showed a foreign object in her neck. She refused CT scans and admission but returned two days later with fever, high blood pressure, and oral infection. This time, through endoscopy and CT scans, doctors found the foreign body in the cervical oesophagus, having caused bilateral perforations.
ENT surgeon Dr Sanjay Helale said, "Scans carried out before the surgery revealed the bone was still in the earlier position." He chose an open surgery as the bone was close to the carotid artery to the brain and the patient's perforated food pipe needed repair. "Perhaps due to manipulations of the oesophagus during dissection or due to the effect of anaesthesia, the bone moved upwards," said Dr Helale, who plans to send the case to a medical journal for publication.
The bone's upward migration has perplexed doctors. Dr Divya Prabhat, ENT head at Wadia Hospital, Parel, said, "The cricopharyngeal sphincter located at the end of the throat and beginning of the oesophagus is the strongest one in the gastrointestinal tract in order to prevent aspiration. Normally, food that goes through it can only move down the gullet and not travel back upwards."
Dr Ajay Bhandarwar, head of the surgery department at J J Hospital, Byculla, said the movement from the food pipe back to the throat was unusual. Former KEM Hospital Dean Dr Avinash Supe suggested: "It's tricky, but one could presume the patient coughed immediately after the anaesthesia was given and the necrosis set in the infected tissues loosened the bone, resulting in upward migration."
Ruby, who was fed through a tube for 21 days, has meanwhile told her husband that she will not eat biryani or cook it.