Dubai: For nearly two months, Unnikrishnan Sivaraman, a 60-year-old Indian expat living in Sharjah, struggled with a persistent cough, chest congestion and increasing difficulty in breathing.
The cause was a sharp fish bone, almost 2 cm long and 1cm wide, that had lodged deep in his airway after he accidentally aspirated it while eating.
On September 11, a team of doctors at Aster Hospital Mankhool in Dubai finally removed it, and he went home within hours, the hospital said in the case details revealed on Monday.
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From uneasy feeling to breathlessness
It began on July 1 when Unnikrishnan accidentally aspirated a milkfish bone while eating.
He first felt uneasy. Later, he had significant nausea and vomited blood-stained matter, so he went to the emergency department at Aster Hospital Al Qusais (AHQ).
But the symptoms did not go away. The cough, chest congestion and breathing difficulty continued and worsened, and he went for further medical consultations.
A CT scan at another hospital then revealed that the fish bone was lodged in his lower airway. He was then referred to AHQ for further management, and then on to Aster Hospital Mankhool, as the case needed specialised intervention.
Why the bone was so hard to remove
Fish bones are among the most common food-associated foreign bodies seen in adults, with a higher incidence reported in Asian populations. In Unnikrishnan's case, however, the bone had slipped into the lower airway and stayed in the vertical airway leading to the right lung.
He arrived at Aster Hospital Mankhool on August 26. The medical team reviewed his CT images and carried out a further assessment, which confirmed that the bone remained lodged in the right main bronchus. Its prolonged presence had caused significant local inflammation and the formation of granulation tissue around it.
Given the bone's size, sharp edges and location, removing it called for careful planning. There was a potential risk of injury to the bronchial wall and surrounding structures, bleeding, sudden airway obstruction and difficulty maintaining adequate oxygenation during manipulation and extraction.
A three-team effort
A multidisciplinary team from Pulmonology, ENT and Anaesthesia planned the procedure, taking into account the location, sharp edges and prolonged presence of the foreign body.
The hospital said Dr Jolsana Augustine, Specialist Pulmonologist, performed bronchoscopy with anaesthesia support from Dr Abhishek Jayaprakash Narayan and Dr Siraj Madayi Meethel, and carefully mobilised the fish bone from the right main bronchus towards the upper airway.
Dr Bharath Neranki Satish Rao, Specialist ENT, then performed direct laryngoscopy and used specialised forceps to remove the foreign body while protecting the vocal cords. A check bronchoscopy was subsequently performed to assess the airway and clear secretions.
Dr Jolsana said: "When a foreign body remains in the airway for a prolonged period, inflammation and granulation tissue can make removal more challenging. In this case, the size, sharp edges and location of the fish bone required careful planning and controlled manipulation. Close coordination between the Pulmonology, ENT and Anaesthesia teams was essential for its safe removal while minimising the risk of airway injury or bleeding."
Dr Bharath said: "The sharp edges of the fish bone and its proximity to the vocal cords made the final stage of extraction particularly delicate. Our focus was to remove the foreign body safely while protecting the vocal cord structures. The successful outcome was made possible by careful coordination between the Pulmonology, ENT and Anaesthesia teams throughout the procedure."
Home within hours
The procedure was completed successfully, and Unnikrishnan was discharged home in a stable condition within a few hours.
At follow-up, he reported significant improvement and was doing well, with no further medical treatment required.
Expressing his gratitude to the medical team, he said: "I am very thankful to Dr Jolsana, Dr Bharath and the entire team at Aster Hospital Mankhool for the care and support I received. Dr Jolsana explained everything clearly and made me feel comfortable throughout the treatment. I am very happy with my recovery and the significant improvement in my breathing and overall condition."