Cervical esophagotomy for foreign body extraction - Case report and comprehensive review of the literature

Migrated Foreign Body of Upper Digestive Tract-A Ten-Year Institutional Experience

The ingested foreign body is one of the commonest emergencies encountered by otolaryngologists Depending on the shape and duration of impaction, a small number of foreign bodies (1-2%) can perforate the wall of the gastrointestinal Tract. A migrated foreign body may remain quiescent or cause life-threatening suppurative and vascular complications. Data were collected retrospectively from the hospital records in a tertiary care hospital in South India from 2010 to 2020. Fifteen patients diagnosed with migrated foreign body and who underwent neck exploration were included in the study. Demographic details, mode of presentation, clinical and radiological findings, rigid esophagoscopy findings, neck exploration techniques employed were noted. The mean age of the patients was 37.66 years. All patients had a history of dysphagia, odynophagia, and point tenderness. All the patients underwent a lateral neck radiograph, and it was positive in 12 patients (80%), while in 3 patients (20%), it was negative. All the patients had a positive finding in Contrast-Enhanced Computed Tomography. Esophagoscopy was done prior to neck exploration to identify the site of injury and the probable site of migration. All the patients underwent lateral neck exploration, and foreign body was removed. Migrated foreign body can cause significant morbidity and mortality if not diagnosed and managed early. Strong suspicion and a systematic approach are needed for the diagnosis and management.

Foreign Body in the Cervical Oesophagus: A Case Report

BACKGROUND

Foreign bodies in the upper aerodigestive tract represent an uncommon cause of visits to emergency departments. In the majority of cases, foreign bodies do not go beyond the pharynx. They cause dyspnoea or pneumonia if they reach the tracheo-bronchial tree. If ingested, they will pass spontaneously through the gastrointestinal canal in the majority of cases. Nevertheless, especially in case of sharp-pointed or large objects, the foreign bodies can stop in the oesophagus. In case of dysphagia, stinging sensation and/or odynophagia occurring after eating a meal, a foreign body in the upper aerodigestive tract should be suspected. If not clinically visible, imaging is required.

CASE PRESENTATION

A 72-year-old woman presented to the Emergency Department with pharyngodynia, odynophagia, stinging, dysphagia, and sialorrhea for 12 hours. Her symptoms started after eating a meal with meat. The patient underwent a standard two-projection radiogram of the neck. The antero-posterior projection radiogram was unremarkable. The lateral projection radiogram showed 16 millimetres in maximum length radiopaque foreign body within the cervical oesophagus. The patient underwent transoral flexible oesophagoscopy under general anaesthesia, with successful removal of the foreign body (bony fragment). Her symptoms improved rapidly after the procedure, and the patient was discharged after 48 hours in good health.

CONCLUSION

A foreign body in the cervical oesophagus may lead to visceral perforation. Once suspected, every effort should be made to identify and remove the foreign body to avoid potentially catastrophic consequences. In some cases, imaging could be necessary to detect the foreign body.

Traumatic xylophagia leading to foreign body removal and tracheostomy in the setting of postpartum psychosis

Postpartum psychosis (PPP) is a severe mood disorder following childbirth that rarely leads to injurious or suicidal behavior. This report illustrates otolaryngologic intervention for pharyngeal laceration and airway instability following traumatic foreign body ingestion in the setting of PPP.

A 25-year-old woman with PPP presented with hemoptysis after attempting suicide by traumatically forcing tree branches into her oropharynx. Imaging revealed pneumomediastinum, and flexible laryngoscopy and esophagoscopy showed a large foreign body (tree branch) extending from the hypopharynx to the gastroesophageal junction. She was taken to the operating room for direct microlaryngoscopy, bronchoscopy and esophagoscopy with removal of the 25-cm tree branch. Panendoscopy revealed a mucosal laceration at the cricopharyngeus with supraglottic and hypopharyngeal edema but no injury to the larynx. Due to airway concerns, a cuffed tracheostomy was placed along with a gastrostomy tube for feeding access. She tolerated her postoperative course with successful decannulation and oral feeding prior to discharge.

Medical Disimpaction for Children With Organic Esophageal Foreign Body in the Era of Eosinophilic Esophagitis

OBJECTIVE

Esophageal foreign body impaction (EFBI) is a common presentation in pediatric emergency medicine. Interventions (medical or endoscopic) are often required because of the severity of symptoms and risk of complications. Use of medical disimpaction (MD) such as glucagon injections and effervescent agents (eg, carbonated beverages) has been well described in adults; however, there are limited data in the pediatric literature. Eosinophilic esophagitis (EoE) is a relatively "new" clinicopathological entity that may present with EFBI mostly due to food with histological findings of EoE. Our study aim was to determine the efficacy of MD for organic EFBI in the pediatric population especially in children with EoE.

METHODS

A retrospective chart review was performed using the International Classification of Diseases codes and the emergency department database of patients presenting with EFBI from January 2010 to December 2014. Response to MD was defined as symptomatic relief of obstruction. Age, object ingested, medical agent used, EoE status, complications, and outcome were recorded.

RESULTS

A total of 317 presentations of EFBI were identified during the study period, of which organic EFBI accounted for 101 impactions (31.9%). Medical disimpaction was attempted for 42 (41.6%) with organic EFBI, resulting in resolution of symptoms for 16 (38.1%). One child with EoE responded to MD compared with 15 without EoE (4.8% vs 71.4%, P < 0.0001).

CONCLUSIONS

Medical disimpaction was ineffective in children with EoE but may be of help with symptom resolution in approximately 70% of children without EoE.

An Unusual Case of Stridor: Severe Tracheal Narrowing Secondary to Esophageal Food Impaction

Foreign body impaction (FBI) in the esophagus has the potential to be a serious condition with a high mortality rate. Although the majority of foreign bodies trapped within the esophagus pass spontaneously, some do require endoscopic intervention. This case discusses a 95-year-old-female with a history of cerebral vascular accident who presented with acute onset respiratory distress with inspiratory stridor. The patient denied any episodes of choking or foreign body sensation. Further imaging revealed a large food bolus within the esophagus with extensive tracheal narrowing. The patient was diagnosed promptly and successfully managed endoscopically. This case presentation emphasizes the need to maintain a high index of clinical suspicion for FBI in high-risk populations, especially when the patient's history makes it unlikely. In the setting of respiratory complications, airway protection remains a priority, but an accurate diagnosis with timely intervention is paramount.

Clinical features and standardized diagnosis and treatment of esophageal foreign bodies

AIM

To summarize the clinical characteristics of esophageal foreign bodies and to explore their standardized diagnosis and treatment.

METHODS

This retrospective study was conducted at our hospital from July 2011 to July 2017, and we reviewed the clinical data for 1190 patients with esophageal foreign bodies with regard to their sex, age, department patients first visited, treatment time, type, incarcerated site, treatment plan, and length of hospital stay.

RESULTS

Of 1190 patients included, 568 were male and 622 were female, with a male-to-female ratio of 1.0:1.1. They aged from 2 mo to 99 years (mean, 45 years ± 28.44 years), with a median age of 54 years; 293 (24.6%) patients were under 15 years, 293 (24.6%) were between 15 and 55 years, and 604 (50.8%) over 55 years. Otolaryngology and head surgery department was the most first-visited department (966, 81.2%), followed by gastroenterology department (138, 11.6%), thoracic surgery department (46, 3.4%), and others (40, 3.4%). There were 716 (60.2%) patients who visited hospital within 24 h, 126 (10.6%) in 24 to 72 h, and 348 (29.2%) over 72 h. The foreign bodies were plant-based in 448 (37.6%) patients, animal-based in 403 (33.9%), metallic in 200 (16.8%), and composite material-based in 139 (11.7%), with jujube pits, chicken bones, and coins accounting for 62.9% (750 patients) of all cases. The foreign bodies were most commonly located in the upper orifice of the esophagus (827, 69.5%), followed by the upper part (245, 20.6%), the middle and lower parts (94, 7.8%), and others (25, 2.1%). We treated 1088 (91.4%) patients by endoscopy and 41 (3.4%) by surgery. The duration of hospitalization ranged from 1 to 71 d (median, 5 d; mean, 5.9 d ± 4.9 d).

CONCLUSION

Esophageal foreign bodies most commonly occur in the upper orifice of the esophagus. Standardized diagnosis and treatment are important. Esophageal foreign bodies should be taken out within 24 h. Timely correction of water and electrolyte disturbance, effective antibiotic therapy, high nutrition support, and temporary esophageal, if necessary, are beneficial to the patient's recovery.

Airway Complications from an Esophageal Foreign Body

Introduction. Foreign body impaction (FBI) in the esophagus can be a serious condition, which can have a high mortality among children and adults, if appropriate diagnosis and treatment are not instituted urgently. 80–90% of all foreign bodies trapped in the esophagus usually pass spontaneously through the digestive tract, without any medical or surgical intervention. 10–20% of them will need an endoscopic intervention. Case Report. We hereby present a case of a large chicken piece foreign body impaction in the esophagus in a 25-year-old male with mental retardation. Patient developed hypoxemic respiratory failure requiring intubation. The removal required endoscopic intervention. Conclusions. Foreign bodies trapped in the upper gastrointestinal tract are a serious condition that can be fatal if they are not managed correctly. A correct diagnosis and treatment decrease the chances of complications. Endoscopic treatment remains the gold standard for extracting foreign body impaction.

Impacted Metallic Spring Requiring Cervical Esophagotomy: A Case Report and Review of the Literature on Foreign Body Removal

Foreign body ingestion is a commonly encountered problem and can cause significant morbidity and mortality. When removal of a foreign body from the upper gastrointestinal tract is indicated, endoscopy is the modality of choice and has a high reported success rate. However, in less than 1% of cases, endoscopic removal of a foreign body is unsuccessful and surgical intervention is necessary. We report a unique case of a large, sharp metallic spring swallowed by an incarcerated patient which subsequently became lodged in his upper thoracic esophagus. This spring was unable to be removed endoscopically due to risk of perforation and cervical esophagotomy was needed for its successful removal, illustrating the limitations of endoscopic techniques in removal of foreign bodies and the role surgical intervention has in these rare instances.