A 1-year-old boy was brought to the Emergency Department with alleged history of accidental ingestion of whole live fish from an aquarium at home, following which he had been coughing associated with excessive drooling of blood tinged saliva and difficulty in breathing.

The incident was witnessed by family at home. On examination in ED, baby was irritable, tachypneic with stridor, the O2 saturation was 95 % on room air with good bilateral air entry on auscultation. Patient's throat was examined which showed excess pooling of saliva only with little blood.  

With difficult airway team at the patient’s side, immediate X-ray soft tissue neck was taken which suggested soft tissue shadow in the cricopharyngeal area with anterior displacement & narrowing of the trachea anteriorly. C

Child was intubated and mechanically ventilated in view of worsening breathlessness and respiratory distress and while doing direct laryngoscopy, blood tinge oral secretions along with vocal cord edema were noted, however, there was no evidence of any foreign body seen.

He was shifted to PICU and an upper GI Endoscopy was done, whole fish was seen at the fundus of stomach which was cut into multiple pieces and removed. There was significant amount of vocal cord edema noted. Baby was managed with ventilator support and supportive medications. Over the course of stay in ICU, his condition improved and he was intubated on day 2 of ICU stay and discharged in stable condition.

This rare case emphasizes the importance of timely diagnosis and safe approach in removal of foreign body which can be near fatal. Caretakers have to be educated about the importance of special attention especially towards smaller kids who are trying to play with live objects.