Vertebral artery dissection due to an esophageal foreign body migration: a case report

Unusual journey of migratory foreign bodies in the alimentary tract

Foreign bodies are uncommon, and the migration of ingested or inserted foreign bodies within or out of the gastrointestinal tract is even rarer. Migration of foreign objects from the digestive system to the soft tissue in the neck, genitourinary tract, or abdominal cavity to intraluminal extension in bowel loops is an uncommon but well-reported occurrence. The accidentally retained surgical sponge (gossypiboma) following abdominal or pelvic surgery with transmural migration within the bowel is an extremely rare clinical presentation. The bowel can be penetrated by retained material, which moves within the bowel lumen, resulting in malabsorption, intestinal obstruction, either partial or complete. In a few cases, spontaneous expulsion occurs. The interpretation is done on radiographs in frontal and lateral projections X-rays, magnetic resonance imaging (MRI), computed tomography (CT), and ultrasonography (USG). Computed tomography (CT) is helpful if a radiopaque foreign body is suspected and is the modality of choice. We share with you 2 instances of foreign items migrating outside the digestive tract with a possible history of ingestion and a case of transmural migration of the postcesarean section retained surgical sponge within the alimentary tract, causing bowel obstruction. Diagnosis and the exact location of a foreign body can be established with the judicious use of different modalities. A CT scan is the modality of choice because it provides a road map for surgical intervention.

Emboli stroke following migration of carotid foreign body: A case report

Foreign body embolization can cause intracranial artery occlusion with ischemic stroke. Reported etiologies include post cerebrovascular interventions, migration of esophageal foreign body and neck trauma. We reported a case with punctured wound at left neck, X-ray and computed tomography revealed a foreign body located in the carotid region. The patient eventually developed stroke symptoms in the next day after operation. Non-contrast brain Computer tomography at that time revealed that porcelain fragment located at the suprasellar area, and infarction of the left anterior basal ganglion. Our patient is the first reported case having an embolic stroke secondary to distal migration of a foreign body from the carotid artery after neck trauma. We call attention to this rare neurologic complication of neck trauma with foreign body retention. Appropriate and prompt identification of concurrent vascular injuries with retention of foreign body is strongly advised in neck trauma patients.

Impacted Pen Cap in Pharynx Leading to Pharyngojugular and Pharyngocutaneous Fistula in an Infant

Foreign body-related injuries to aerodigestive tract and large neck vessels are rare but can be catastrophic if not identified and treated in time. We report an infant with impacted foreign body (pen cap) in the pharynx which went unnoticed until it led to the formation of a fistula with the internal jugular vein (IJV) and massive hemorrhage. His course was complicated by ventilator-associated pneumonia, air leaks, shock, acute kidney injury, prolonged mechanical ventilation, and pharyngocutaneous fistula. The surgical removal of foreign body, ligation of IJV, closure of pharyngeal defect, and supportive treatment in pediatric intensive care unit led to a favorable outcome. This is the first case of pharyngojugular and pharyngocutaneous fistula following an impacted foreign body in the pharynx.

Ballistic Reconstruction of a Migrating Bullet in the Parapharyngeal Space

A 21-year-old male suffering from severe throat pain after being hit by a bullet in Syria claimed that he was shot through his eye and that the bullet subsequently descended behind his throat. Even though the first medical report stated that this course is implausible, meticulous workup provided evidence that the bullet might have entered the parapharyngeal space in a more cranial position than the one it was found eight months later. Our case highlights that bullets are able to move within the body, rendering ballistic reconstruction difficult. However, after removal of the bullet the patient's symptoms completely resolved.