Incidence of foreign bodies’ (FB) ingestion is usually greatest in children aged 6 months to 6 years [1]. The spectrum of presentation varies widely from sudden death due to respiratory obstruction to accidental finding during routine investigation. Occasionally, we also find younger children may be "fed" foreign bodies by older children [2].

A 6-month-old male infant was brought to our emergency room by parents with sudden onset of difficulty in breathing. Further history revealed accidental self ingestion of whole live fish given in baby’s hand by his elder sibling while cleaning the aquarium at home. Incidentally this was witnessed by the father. On examination, baby was afebrile, cyanosed with increased breathing efforts and saturation was 76%. General physical examination was normal. On systemic examination, there was bradycardia and bilateral air entry was absent. Within a minute, baby developed labored breathing. Immediately baby was taken for intubation. While passing laryngoscope for intubation, we noticed pooling of blood in the oral cavity. After suctioning, the tail part of the fish was visible in the throat. The fish was removed with help of Magill forceps with gentle manipulation. Chest movements improved with good air entry on auscultation. Post-removal, vitals were stable. Baby maintained saturation without oxygen. Chest X-ray was taken to rule out aspiration. Antibiotics were started and supportive care continued. Baby was observed for 24 hrs in intensive care unit and discharged on third day on stable vitals; follow-up after a week was uneventful. Fish was 6.5 cm in length and 3 cm in breadth, and blood stained.

Fig.1 Blood-stained fish immediately after removal.

The enhanced risk of aspiration in this age group is attributed to inherent anatomic and physiologic characteristics like inadequately developed posterior dentition, immature neuromuscular mechanisms of deglutition, airway protection and the ubiquitous tendency of putting objects into the mouth. An unattended vulnerable child and easy access to small objects are also contributory [1,3].The majority of ingested foreign bodies will pass spontaneously [4]. Walvekar, et al. reported one case of accidental ingestion of live fish in infant, where it was ‘bathini fish medicine’ used for treatment of asthma [5].

Keeping aquariums at home has become a trend in modern lifestyle. Usually children are interested to watch, touch and play with this kind of live objects. This unusual case emphasizes the importance of caregivers’ special attention to this vulnerable age group and also importance of timely diagnosis and intervention.

1. Shubha AM, Das K. Trachiobranchial foreign bodies in infants. International J Pediatric Otorhinolaryngol. 2009;73:1385-9.

2. Taksande A, Vilhekar K, Tyagi V. Uncommon foreign body aspiration in infant. Calicut Med J. 2010; 8:e8. Available from: www.calicutmedicaljournal.org/2010/1/e8.pdf. Accessed on 1 April, 2013.

3. Mu LC, Sun DQ, He P. Radiological diagnosis of aspirated foreign bodies in children: review of 343 cases, J Laryngol Otol. 1990;104:778-82.

4. Byard RW. Mechanism of unexpected death in infants and young children following foreign body ingestion. J Forensic Sciences JFSCA. 1996;41:438-41.