A teenager in Bangladesh found when the fishing gets tough, catch big fish with your teeth. The unidentified boy caught an eel and then grabbed a hold of it with his mouth to use his hands to catch another one. The teen experienced difficulty breathing as the wriggling eel worked its way down his throat, which landed him at Dhaka Medical College Hospital for an emergency operation, according to a case report published in the journal BMC Research Notes.

“Cases like this are very rare,” said Dr. Kanu Saha, the boy’s surgeon, the Daily Mail reported. “He is very lucky to be alive.” This is Saha’s second case to date related to a live foreign body lodged in the trachea or bronchus. He previously treated a 45-year-old man who swallowed a fish and came from a rural village about 200 miles away but did not survive.

In both cases, the live fish lodged in the windpipe and airways, known as an “acute emergency condition.” The invasion of a foreign body in the tracheobronchial tree usually stimulates symptoms of coughing and wheezing. The obstruction of the esophagus produces drooling and spitting up whatever fluid is swallowed. The most common foreign bodies in the throat are pieces of plastic, metal pins, seeds, nuts, bones, coins, and dental appliances, according to the journal of the American Family Physician.

Doctors determined the teen boy had swallowed a fish known locally as Guchi Baim, or an Indian spiny eel, measuring 6.3 inches. This made it difficult to diagnose and manage because the fish can stop the patient from being able to communicate, and because different types of fish can get stuck in different areas. For example, big fish tend to lodge themselves in the back of the throat, while a small, flat, or long fish might be able to go through the throat and into the airways.

“So a quick short history from accompanying persons, especially about the type of fish, is crucial to predicting the site of its lodgement in the airway as well as management plan,” Saha said.

Boy has eel pulled out of throat Doctors removed a 6.3-inch eel from a teen boy's throat after a fishing incident. BMC Research Notes

At first, doctors examined his throat and saw some lacerations, but they could not see the fish either. The emergency surgery involved cutting the front of the boy’s neck and inserting a tube into his windpipe to help him breathe, but it didn't provide sufficient air to his lungs. Shah and the other surgeons used a pair of forceps to grab the eel and simply pull it out. The teen boy survived and was discharged from the hospital.

The Bangladeshi teen’s case mirrors an incident in India where a boy was treated at Terna Medical College and Hospital in India to remove a fish from his throat. In a YouTube video uploaded by Dr. Fuzail Pathan, part of the Department of ENT at the hospital, the surgeon shows how he swiftly removes a whole fish from the distressed boy using forceps.

Pathan warns: “The interesting part is that such foreign bodies in the oral and respiratory tracts are rare, and if not quickly taken care of, may lead to a disaster.”

As a common courtesy and life-saving practice, do not open your mouth and fish at the same time.