Penetrating esophageal injury by ingestion of a wire bristle

Hazards and Management of Wire Bristle ingestions: A Systematic Review

OBJECTIVE

Inadvertently ingested grill brush bristles can lodge in various locations and lead to a variety of injuries. They can also be difficult to identify and remove. Our primary objective was to perform a systematic review of cases reported in the literature, with analysis of trends in clinical presentation and success of diagnostic modalities and treatment approaches.

DATA SOURCES

Cases of reported grill brush bristle ingestion reported in PubMed, PubMed Central, and Google Scholar databases through April 30, 2021.

REVIEW METHODS

Databases were searched for the following terms: ("ingestion" OR "injury" OR "barbeque" OR "BBQ" OR "grill" OR "foreign body" OR "brush" AND "wire" OR "bristle"). Data were collected on patient demographics, clinical presentation, and treatment course. Statistical analysis was performed on characteristics with low risk of confounding.

RESULTS

An overall 57 studies involving 91 patients were included. Grill brush bristles presented most commonly in the upper aerodigestive tract (48/91), followed by the abdomen (26/91) and deep neck (17/91). Computed tomography was the most accurate imaging modality for initial diagnosis, identifying 92.8% of bristles. Less invasive or adjunctive techniques such as endoscopy, intraoperative imaging, or minimally invasive surgery may be useful particularly for bristles located in the head and neck given the low rate of success of transoral surgery (66.7%).

CONCLUSION

Although this review of retained bristle may be biased toward complex cases, retained grill brush bristles represent an underrecognized and difficult-to-manage hazard. When cases are suspected, clinicians should obtain computed tomography imaging based on presentation and tailor management appropriately.

Wire bristle foreign body: Never in the same place twice

Foreign body ingestion is a common reason for visiting the emergency room. Foreign bodies can lodge anywhere in the upper aerodigestive tract and can sometimes be difficult to extract. Wire bristles that dislodge from grill-cleaning wire brushes and which are then accidentally swallowed can be particularly challenging to remove due to their small size, propensity to become embedded, and their ability to migrate through tissues. This case reveals the speed with which wire bristle foreign bodies can migrate through tissues and exemplifies the need to obtain computerized tomography evaluations in close proximity to any planned attempt to remove them.

The Dangers of Barbecuing: An Interesting Case of a Foreign Body in the Throat

Swallowing of foreign bodies (FB), and sensation of such in the throat, is a common complaint in the emergency department setting, with roughly 80,000 visits in 2010 for FB ingestion.1 Grill wire brushes are a rarely reported, accidental FB ingestion, although recent literature suggests that it is more common than initially thought.2 This is a report of a female with acute onset odynophagia after a meal, with a normal laryngoscopic exam that used flexible fiberoptics. Evidence of a metallic linear density was present in the retropharynx on computed tomography imaging, most consistent with a wire from a grill wire brush.

Grill-Cleaning Wire Brush Bristle Ingestion: Case Series and Review of the Literature

Objectives:

The authors report a small case series of an unusual ingested foreign body, wire brush bristles, whose small size can present a challenge for endoscopic removal. The authors describe transnasal endoscopic removal and provide a literature review.

Methods:

From 2011 to 2017, 8 patients presented to an academic tertiary medical center with ingestion of wire brush bristles. The patients’ medical records were reviewed and are described in this report, along with a literature review.

Results:

In 4 patients, the bristles were in the lingual tonsils. In 1 patient, a bristle was within the pharyngoepiglottic fold and lingual tonsils. Three patients underwent office removal with a fiber-optic laryngoscope under local anesthesia. Two patients underwent direct laryngoscopy with bristle removal. In 1 patient the wire bristle transected the esophagus, requiring an open procedure. One patient presented with a complicated deep-space neck infection.

Conclusions:

Wire brush bristles easily become displaced and subsequently become lodged in the upper aerodigestive tract. Localization of a bristle can be difficult on examination and laryngoscopy. Radiography can be performed, but computed tomographic examination with contrast is superior for precise localization for preparation for an operative approach. Depending on the precise location of the bristle, endoscopic removal using a fiber-optic channeled scope may be a safe and effective solution.

Level of Evidence:

Case Series, IV

Female Adolescent Presenting With Abdominal Pain: Accidental Wire Bristle Ingestion Leading to Colonic Perforation

INTRODUCTION

Abdominal pain in female adolescents is a common presentation to both the emergency department and the outpatient pediatric clinic. The broad differential diagnosis for abdominal pain requires a high index of suspicion to make an accurate diagnosis of foreign body ingestion as the etiology. Foreign body ingestion occurs in all age groups, but sequelae of gastrointestinal tract perforation in children are rare. Treatment for perforation requires consultation of the pediatric general surgeon. Clinicians should take care to not overlook subtle imaging findings or dietary/exposure history, even in the context of a patient with known history of abdominal pain.

CASE REPORT/TECHNIQUE DESCRIPTION

We report the accidental ingestion of a wire bristle from a grill cleaning brush by a female adolescent. The patient, previously treated and seen for constipation and irritable bowel syndrome in the outpatient gastroenterology clinic, was referred to the emergency department after identification of a foreign body on abdominal radiography. Emergency department physicians discovered the history of grilling and consumption of grilled food, facilitating diagnosis of a wire bristle as the foreign body. The metallic foreign body had migrated to the colon, where it perforated and lodged into the abdominal wall, causing acute, focal symptoms. Observation in the hospital with pain control and infection management allowed for elective laparoscopy. The surgical team removed the object with minimal morbidity and avoided laparotomy.

DISCUSSION

Reports of unintended ingestion of wire bristles have been increasingly reported in the literature; however, most focus on injury to the upper airway or upper digestive tract and subsequent endoscopic or laryngoscopic removal. Most reports detail injury in adult patients, pediatric case reports with digestive tract injury are uncommon, and foreign body removal after lower digestive tract injury in children from a wire bristle has not been reported. We caution pediatric emergency medicine and ambulatory providers to consider such an ingestion and perforation in the differential diagnosis of acute-onset, focal, and localizable abdominal pain in children.

Small Bowel Perforations by Metallic Grill Brush Bristles: Clinical Presentations and Opportunity for Prevention

Increasing reports on the incidental ingestion of metallic bristles from barbeque grill cleaning brushes have been reported. We sought to describe the clinical presentation and grilling habits of patients presenting after ingesting metallic bristles in an attempt to identify risk factors. We performed a chart review of six patients with documented enteric injury from metallic bristles. Subjects were contacted and administered a survey focused on the events surrounding the bristle ingestion. We arranged for in-home visits to inspect the grill and grill brush whenever possible. Of the six subjects identified, three (50%) were male, five (83%) were white, and they ranged in age from 18 to 65 years (mean 42.5). All complained of abdominal pain. All bristles were identified by CT scan. Three patients underwent laparoscopic enterorrhaphy, and two underwent laparotomy. The remaining patients did not require intervention. None had replaced their grill brush in at least two years. Surgeon's awareness of this unusual injury is important to identify and manage this problem. Alternative methods to clean the grill should be sought and grill brushes should be replaced at least every two years.

Epidemiology of Wire-Bristle Grill Brush Injury in the United States, 2002-2014

Objectives

The purpose of this study was to investigate the epidemiology of wire-bristle grill brush injury.

Study Design and Setting

Cross-sectional analysis of national databases; literature review.

Subjects and Methods

The Consumer Product Safety Commission’s National Electronic Injury Surveillance System (NEISS) was used to derive a national weighted estimate of emergency department visits for wire bristle injury from 2002 to 2014. Date, location of injury, demographics, and outcomes were analyzed. A literature search and a consumer-reported injury database ( SaferProducts.gov ) were interrogated to provide ancillary sources of data.

Results

A total of 43 cases were found within the NEISS database, which extrapolated to an estimated 1698 (95% confidence interval, 1468-1927) emergency department visits nationwide. In the NEISS database, the mean age was 30 years, and the sex distribution of the patients was similar (21 males vs 22 females). The most common location of injury was the oropharynx in both the NEISS database (23 of 43, 53.4%) and the literature review (11 of 36, 30.5%). However, the oral cavity was the most frequent site in the consumer-reported SaferProducts.gov database (9 of 24, 37.5%). The majority of patients in the NEISS were treated in the emergency department (31 of 43, 69.7%). Raw case counts were highest in June, July, and August, with the highest number of events in the month of July.

Conclusion

Injury from wire-bristle grill brush is uncommon but prevalent during certain seasons. Otolaryngologists play an important in the diagnosis and treatment of these injuries. Awareness among consumers and product manufacturers is necessary to promote safety.

Multimodality imaging of esophageal perforation by a wire bristle

Complete extra-esophageal migration of a foreign object is rare. Its early and accurate diagnosis by complementary imaging modalities is crucial for a successful extraction. We present a case of ingested wire bristle, which completely traversed the esophageal mucosa to position itself in the soft tissue of the left neck adjacent to the internal carotid artery. We discuss the importance of imaging in the detection of migrating foreign bodies, and raise awareness of this serious complication.

Management of Wire Brush Bristle Ingestion

Objectives:

To increase awareness of wire brush bristle ingestion, review the literature relating to wire brush bristle ingestion, and describe an algorithm for management of wire brush bristle foreign bodies as well as a technique for bedside removal.

Methods:

The authors present a case of an accidental wire bristle ingestion that was successfully treated with bedside removal and describe a successful bedside technique for removal. For the literature review, the PubMed journal database and Google Scholar were queried using the search terms wire bristle, wire brush, grill brush, and grill bristle.

Results:

Twenty-three wire brush ingestions with upper aerodigestive presentations were identified in the medical literature. Bedside visualization was attempted in 10 patients and successful in 5. The foreign body was able to be removed at the bedside in 3 of these patients. Two patients were managed conservatively. The authors developed an algorithm for management based on these literature findings.

Conclusion:

Wire brush bristle ingestion is increasingly common in the literature, and a definitive algorithm does not exist for management. The authors present an algorithm for management and describe a technique for successful removal at the bedside.

Removal of a wire brush bristle from the hypopharynx using suspension, microscope, and fluoroscopy

Wire brush bristles are an increasingly recognized hazard that can present as a foreign body in the aerodigestive tract. Due to their small size and tendency to become embedded in surrounding tissue, these small metallic bristles present a unique operative challenge to otolaryngologists. Here we present a case of a 40-year-old woman who underwent endoscopic extraction of a wire bristle from the posterior pharyngeal wall using suspension, microscopy, and C-arm fluoroscopy. We believe this is the first published case of an endoscopic removal of a buried foreign body in the hypopharynx using these methods of localization concurrently. By leveraging multiple techniques for visualization, surgeons can avoid open exploration while ensuring complete removal of the object. Additionally, this case highlights the importance of regulatory oversight and consumer awareness of the hazards of grill brushes.

Accidental Ingestion of a Grill Brush Wire Resulting in Death

Accidental ingestion of a foreign body is a rare occurrence in the unimpaired adult. The usual patient is aware of the ingestion event and seeks medical attention if needed.

We report a case of accidental, unrecognized, fatal ingestion of a foreign body discovered during a postmortem examination. In situ examination revealed a small perforation of the terminal ileum by a perforating metal wire. Fibrinopurulent peritonitis was the immediate cause of death. The foreign body was later found to closely resemble the wire bristles of a barbeque grill brush that family members brought to a family/clinician/pathologist conference.

There are few previous case reports of ingestion of a grill brush wire, all of which were nonfatal. Health care workers, including pathologists, should be aware of this potential ingestible foreign body given the widespread use of barbeque grills in food preparation. Additionally, manufacturers and users of grill brushes should be well aware of this ingestion hazard.

The management of accidental wire brush bristle ingestions: A combat military perspective

There has been an increasing recent trend in accidental ingestion of wire barbeque grill brush bristles. Because of the unique nature of the foreign object, both the diagnosis and management of this injury are new realms in everyday trauma without clearly established protocols. We present the case of an accidental wire bristle ingestion resulting in oesophageal perforation; with insight from recent military trauma data, we managed this patient conservatively without surgical exploration. In the subset of asymptomatic patients with negative imaging, this divergence from operative management is safe with close observation and follow-up.

Backyard hazard: a case series of ingested grill brush bristles and a novel approach to extraction

OBJECTIVES

To report a small case series of an unusual ingested foreign body and a new method for removal of tongue base foreign bodies.

METHODS

Three patients were identified with wire bristle foreign bodies between 2009 and 2011 at our academic tertiary medical center. Their medical records were reviewed and are described in this report.

RESULTS

Each patient presented to our medical center with progressive pain after ingestion of barbecued food. For 2 patients, the metallic bristle foreign body was imbedded within the lingual tonsil. In these 2 cases, radiofrequency plasma ablation (coblation) assisted partial lingual tonsillectomy was performed to identify the foreign body. In a third case, the foreign body presented as a complex deep space neck abscess and an open trans-cervical approach was required.

CONCLUSION

While oropharyngeal and esophageal foreign bodies are common, there are only a few case reports describing this particular foreign body. The presentation of an imbedded wire grill brush bristle can be insidious. Persistent pain and foreign body sensation should be taken seriously in patients with a history of barbecue food ingestion. Intraoperatively, wire bristles can be difficult to localize and extract. Radiofrequency plasma assisted lingual tonsillectomy may be helpful for identifying and removing foreign bodies that are imbedded in the tongue base. Grill brushes should undergo stringent safety regulation, as ingested wire bristles are difficult to localize and remove and may cause significant morbidity.

Wire grill brush bristle as an unusual foreign body: report of two pediatric cases

Wire grill brushes are commonly used for cleaning grill grates. Accidental ingestion of a wire bristle from a grill-cleaning brush is a rarely reported foreign body, with only three prior case reports. Although scarce in the literature, we encountered two pediatric cases at the regional children's hospital within 1 year. By presenting these two cases, our goal was to raise awareness of this potentially hazardous foreign body. Additionally, we raise a consumer safety issue associated with the use of wire grill-cleaning brushes as there are currently no ingestion hazard warnings on these products. Laryngoscope,, 2011.

Esophageal Injury with Unusual Trauma

Esophageal foreign bodies are frequently encountered in the pediatric population and specific high-risk groups of adults. Foreign bodies in the esophagus can result in serious complications, depending on the size and the shape of the ingested object. We report the case of a four-year-old boy with an esophageal injury after the accidental ingestion of an umbrella wire.