Migratory pharyngeal foreign bodies and related complications: Analysis of 20 cases

Ensuring that ingested fishbones that migrate to the neck are located, diagnosed, and removed early

OBJECTIVES

The aim of this retrospective study was to explore the clinical characteristics of and diagnostic and therapeutic strategies for the removal of fish bones that migrate to the neck.

METHODS

We reviewed the clinical data of 30 patients over the past 12 years who underwent neck surgery in our otorhinolaryngology department for the migration of fish bones from the throat. The location of fish bones and the positivity rate of different examination methods (neck CT and B-ultrasound) were evaluated statistically. The diagnosis and treatment strategy for fish bone migration to the neck was also summarized.

RESULTS

A total of 24 patients had a history of foreign body ingestion. The duration from foreign body ingestion to the appearance of symptoms in the neck ranged from 26 to 151 days, with a median of 50 days (interquartile range, 32-86 days). Among the 24 patients with fish bones located in the front or side of the neck, 50% (12/24) and 100% (24/24) of whom had positive neck CT and B-ultrasound results, respectively. Additionally, for 6 patients with fish bones in the retropharyngeal space, the positive rate for neck CT was 100%, whereas neck B-ultrasound showed negative results due to the air and depth in the trachea and esophagus. A strong correlation was observed between the length of fish bones detected by B-ultrasound and CT and the actual length. Indeed, no significant difference was observed between the length of fish bone determined by B-ultrasound and the actual length. In patients with fish bones located in the anterior and lateral neck regions, the foreign bodies were successfully removed by a lateral cervical approach operation (23/24). For the 6 cases with fish bones located in the retropharyngeal space, all (6/6) were removed by incising the posterior pharyngeal wall with assistance from transoral endoscopy.

CONCLUSIONS

The techniques of B-ultrasound and CT have advantages for the diagnosis of migratory foreign bodies in the neck. Although B-ultrasound is more accurate for estimating the length of migratory fish bones in the neck, a combination of both methods can improve the preoperative positive rate of diagnosis. Therefore, a variety of surgical approaches should be employed to manage the different locations of cervical foreign bodies.

Removal of a fish bone endangering the common carotid artery under general anesthesia with video laryngoscope: A case report

A fish bone penetrating the digestive tract is a common emergency, and its removal often requires endoscopy. We report herein a case in which a fish bone punctured the throat; its front end was close to the common carotid artery, but its back end could not be visualized. Subsequently, we compared the pharyngeal CT and carotid CTA of the patient and found that the fishbone had shifted. So we considered that the end of the fish bone could be rediscovered and successfully removed by a video laryngoscope. Finally, with the patient under deep sedation with maintained spontaneous breathing, the fish bone was removed using video laryngoscopy. This case highlights the importance of rechecking CT scans and the use of laryngoscopy when determining the location of a shifted foreign body at different times and when selecting the removal method.

Multidisciplinary Team in Severe Infectious Complications Caused by Pharyngeal Foreign Body

BACKGROUND

Pharyngeal foreign body is not only a common emergency in people's daily life, but also a common simple disease in otorhinolaryngology. However, the disease is easy to be ignored due to its common occurrence, which may lead to a series of serious complications including sepsis and local abscess.

CASE PRESENTATION

In this case, a patient with sepsis, piriform fistula, deep neck abscess, and mediastinal abscess caused by a fishbone was reported. After reviewing the international literature on severe infectious complications caused by foreign bodies in pharynx, the authors emphasize the important role of multidisciplinary team in dealing with complex complications.

RESULT

The whole process of patient from onset to recovery was summarized in a timeline. During hospitalization, the value of leukocyte counts and C-reactive protein in routine blood test was record dynamically. The electronic laryngoscopy, neck computed tomography and chest computed tomography were used to judge treatment efficacy. After about 2 months of hospitalization, the patient was recovered without sequelae. No adverse reactions were found during the follow-up.

CONCLUSION

The incorrect method of removing foreign body after mis-swallowing may develop serious complications. Therefore, It is important to strengthen medical preaching for general population of correct treatments after foreign body ingestion. In addition, the case reminds clinicians to pay more attention to patients' medical history and details of all medical examinations, which may provide significant clues for making the correct diagnosis and treatment quickly.

Intestine perforation by an accidental ingested SARS-CoV-2 nasopharyngeal swab; a case report

Introduction and importance

Gastrointestinal tract perforations as a result of foreign body ingestion are rare. Most ingested foreign bodies pass the intestines without complications. However, in 1 % of cases intestinal perforation occurs. We present the case of a 56-year old patient with an extensive surgical medical history who presented at the emergency department with progressive abdominal pain two weeks after accidental SARS-CoV-2 swab ingestion.

Case presentation

On presentation patient was tachycardic and had generalized abdominal tenderness. A CT scan showed free intraperitoneal air and fatty infiltration of the ileocecal anastomosis (after an ileocoecal resection at the age of 46) continuing to the distal sigmoid. Emergency exploratory laparotomy revealed a covid swab in the abdominal cavity with an indurated area of the sigmoid without perforation. Post-operative care was uneventful, and patient was dismissed after four days.

Clinical discussion

Due to his medical history and the fact he was advised to regularly self-test for COVID, he routinely performed an oropharyngeal swab. Unfortunately, this resulted in swallowing the swab. A perforation tends to happen in regions of acute angulation, such as an anastomosis. Although the CT scan suggested the perforation was at the ileocecal anastomosis, no perforation was found during surgery, while the swab was found loose in the peritoneal cavity.

Conclusion

Initial treatment should focus on endoscopic removal. In the case of gasto-intestinal perforation, surgery becomes the treatment of choice. A foreign body can migrate to peritoneal cavity without peritonitis or visible perforation perioperative.

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To the authors best knowledge this is the first case of intestinal perforation after an ingested SARS-CoV-2 nasopharyngeal swab.

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A foreign body can migrate to peritoneal cavity without peritonitis or visible perforation perioperative.

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If endoscopy fails to remove it and there is a high risk of perforation, surgical removal should be considered before severe complications develop.

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In the case of gasto-intestinal perforation, surgery becomes the treatment of choice.