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Tuan HX, Hung ND, Quang NN, Tam NT, Anh NTH, Hoa T, Dung BT, Duc NM. Pulmonary artery penetration due to fish bone ingestion: A rare case report. Radiol Case Rep 2024; 19:1900-1906. [PMID: 38425774 PMCID: PMC10904187 DOI: 10.1016/j.radcr.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/01/2024] [Accepted: 02/03/2024] [Indexed: 03/02/2024] Open
Abstract
Accidental fish bone ingestion is a common manifestation at emergency departments. In most cases, ingested foreign bodies usually pass uneventfully through the gastrointestinal tract and complications only present in less than 5% of all patients. In this report, we present the first documented case of pulmonary artery injury due to a fish bone in a 63-year-old male patient hospitalized with hemoptysis after accidentally swallowing a fish bone 30 days ago. This patient subsequently had surgery and endoscopy to safely remove the foreign body and then recovered well on a follow-up examination. For cases of fish bone ingestion, contrast-enhanced chest computed tomography is one of the most essential tools to assess vascular problems and associated mediastinal infections-risk factors for life-threatening and long-term recurrent inflammation. Reconstructing planes along the foreign body axis and changing windows when analyzing CT scans is necessary to avoid missing lesions and dilemmas.
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Affiliation(s)
- Ho Xuan Tuan
- Department of Medical Imaging, Da Nang University of Medical Technology and Pharmacy, Danang, Vietnam
| | - Nguyen Duy Hung
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
- Department of Radiology, Viet Duc Hospital, Hanoi, Vietnam
| | | | - Nguyen-Thi Tam
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
| | | | - Tran Hoa
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Bui The Dung
- Department of Cardiology, University Medical Center HCMC, Ho Chi Minh City, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
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2
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Liang B, Liu Y, Cai Q, Hou M. Esophageal foreign body penetrating the aorta removed under conventional gastroscope: A case report. Asian J Surg 2024:S1015-9584(24)00649-3. [PMID: 38599966 DOI: 10.1016/j.asjsur.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/03/2024] [Indexed: 04/12/2024] Open
Affiliation(s)
- Baolei Liang
- The Fifth Affiliated Hospital, Southern Medical University, Guangzhou, 510900, China
| | - Yunen Liu
- Shuren International College, Shenyang Medical College, Shenyang, 110801, China
| | - Qingyong Cai
- The Fifth Affiliated Hospital, Southern Medical University, Guangzhou, 510900, China.
| | - Mingxiao Hou
- Shuren International College, Shenyang Medical College, Shenyang, 110801, China.
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3
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Syamal MN. Adult Esophageal Foreign Bodies. Otolaryngol Clin North Am 2024:S0030-6665(24)00003-3. [PMID: 38350826 DOI: 10.1016/j.otc.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
This manuscript reviews and outlines the necessary tools to efficiently assess and manage an adult patient where an esophageal foreign body is suspected. It reviews the vulnerable populations and relevant diagnostics and provides a triage diagram to aid in timely intervention. Management with esophagoscopy is reviewed as well as potential complications that may arise. Lastly, to illustrate the concepts of this section, a case study is presented to highlight the salient points.
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Affiliation(s)
- Mausumi N Syamal
- Laryngology, Department of Otorhinolaryngology, Division of Laryngology, Rush University Medical Center, 1611 West Harrison Street, Suite 550, Chicago, IL 60612, USA.
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4
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Sezer HF, Eliçora A, Topçu S. Foreign body aspirations with rigid bronchoscopy and esophagoscopy in children. Turk Gogus Kalp Damar Cerrahisi Derg 2024; 32:S55-S59. [PMID: 38584785 PMCID: PMC10995683 DOI: 10.5606/tgkdc.dergisi.2024.25688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 11/29/2023] [Indexed: 04/09/2024]
Abstract
Foreign body aspirations and esophageal foreign bodies are lifethreatening conditions. Sometimes they or their complications can cause severe morbidity and even mortality. Their exact incidence is unknown. Foreign body aspirations and esophageal foreign bodies are most commonly observed in the pediatric age group. While interventions are generally required for the removal of respiratory tract foreign bodies, the majority of esophageal foreign bodies come out spontaneously. Removal of foreign bodies that block the lumen of the organ to a great extent, react with the mucosa such as battery magnets, and can cause poisoning, sharp-edged objects, and swellable foreign bodies such as legumes, should be done acutely. In the removal of foreign bodies, endoscopic methods (flexible/rigid bronchoscope) are used in the respiratory system. Other methods used in esophageal foreign bodies are follow-up and pushing and pulling maneuvers with equipment, and at times, open surgical procedures can be applied. The success of the procedures is high, and patients can be discharged in the early postoperative period. Their incidence can be decreased by raising awareness on the subject, parents can be prevented from making wrong applications in these cases, and clinicians can keep these conditions in mind in differential diagnosis. In this article, the clinical features and diagnosis and treatment methods of foreign body aspiration and esophageal foreign bodies will be discussed separately.
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Affiliation(s)
- Hüseyin Fatih Sezer
- Department of Thoracic Surgery, Kocaeli University Faculty of Medicine, Kocaeli, Türkiye
| | - Aykut Eliçora
- Department of Thoracic Surgery, Kocaeli University Faculty of Medicine, Kocaeli, Türkiye
| | - Salih Topçu
- Department of Thoracic Surgery, Kocaeli University Faculty of Medicine, Kocaeli, Türkiye
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Erginel B, Kaba M, Karadag CA, Yildiz A, Demir M, Sever N. Foley catheter technique for the extraction of coins lodged in the upper esophagus of children. BMC Pediatr 2023; 23:605. [PMID: 38031091 PMCID: PMC10687970 DOI: 10.1186/s12887-023-04328-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 09/25/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION Coins are the most commonly ingested foreign bodies in children. They usually become lodged in the upper oesophagus and should be managed immediately. The aim of the present study was to evaluate the characteristics and outcomes of patients with coins lodged in the upper oesophagus, who underwent coin removal using a silicone Foley balloon catheter without fluoroscopy or anaesthesia and evaluate the safety of the procedure. MATERIALS AND METHODS Patients who were admitted from January 2007 to December 2022 for coins lodged in the oesophagus and extracted with silicone Foley balloon catheter without anestehesia were evaluated retrospectively. We focused on the patient characteristics and clinical presentations, and the treatment safety, efficacy, and outcomes. RESULTS 773 patients (416 male, 357 female), with a mean age of 3.5 years (range 6 months to 16 years), who ingested coin and extracted with Foley catether is included. The majority of patients (n = 728, 94.17%) were successfully managed by silicone Foley balloon catheter extraction. Our overall success was 94.17%, with 88.30% of coins retrieved and 5.9% pushed into the stomach. Patients who were successfully treated with Foley catheter were discharged on the same day except for 7 (0.90%) who had minimal bleeding. Only 45 (5.82%) patients required oesophagoscopy in the operating room and these patients were kept overnight for clinical follow-up, without any further interventions. CONCLUSION A Foley balloon catheter can be used to safely and effectively remove coins that are lodged in the upper oesophagus avoiding the risk of general anesthesia.
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Affiliation(s)
- Basak Erginel
- Istanbul Medical Faculty, Department of Pediatric Surgery, Istanbul University, Istanbul, Turkey.
| | - Meltem Kaba
- Department of Pediatric Surgery, Sarıyer Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Cetin Ali Karadag
- Department of Pediatric Surgery, Sarıyer Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Abdullah Yildiz
- Department of Pediatric Surgery, Sarıyer Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Mesut Demir
- Department of Pediatric Surgery, Sarıyer Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Nihat Sever
- Department of Pediatric Surgery, Sarıyer Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
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Tarar ZI, Farooq U, Bechtold ML, Ghouri YA. Cap-assisted endoscopy for esophageal foreign bodies: A meta-analysis. World J Meta-Anal 2023; 11:238-246. [DOI: 10.13105/wjma.v11.i5.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Esophageal foreign bodies are common around the world. Newer approaches, such as cap-assisted endoscopy, have been introduced as an alternative to conventional methods. Therefore, we performed a meta-analysis ono cap-assisted endoscopy versus conventional endoscopy for removal of esophageal foreign bodies.
AIM To investigated the effectiveness of cap-assisted endoscopy with conventional endoscopy.
METHODS An extensive literature search was performed (December 2021). For esophageal foreign body removal, cap-assisted endoscopy was compared to conventional endoscopy for procedure time, technical success of the procedure, time of foreign body retrieval, en bloc removal, and adverse event rate using odds ratio and mean difference.
RESULTS Six studies met the inclusion criteria (n = 1305). Higher odds of technical success (P = 0.002) and en bloc removal (P < 0.01) and lower odds of adverse events (P = 0.02) and foreign body removal time (P < 0.01) were observed with cap-assisted endoscopy as compared to conventional techniques.
CONCLUSION For esophageal foreign bodies, the technique of cap-assisted endoscopy demonstrated increased en bloc removal and technical success with decreased time and adverse events as compared to conventional techniques.
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Affiliation(s)
- Zahid Ijaz Tarar
- Department of Internal Medicine, University of Missouri, Columbia, MO 65212, United States
| | - Umer Farooq
- Department of Medicine, Loyola University, Chicago, IL 60153, United States
| | - Matthew L Bechtold
- Department of Medicine, University of Missouri - Columbia, Columbia, MO 65212, United States
| | - Yezaz A Ghouri
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65212, United States
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7
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Tarar ZI, Farooq U, Bechtold ML, Ghouri YA. Cap-assisted endoscopy for esophageal foreign bodies: A meta-analysis. World J Meta-Anal 2023; 11:38-46. [DOI: 10.13105/wjma.v11.i1.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/11/2022] [Accepted: 12/21/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Esophageal foreign bodies are common around the world. Newer approaches, such as cap-assisted endoscopy, have been introduced as an alternative to conventional methods. Therefore, we performed a meta-analysis ono cap-assisted endoscopy versus conventional endoscopy for removal of esophageal foreign bodies.
AIM To investigated the effectiveness of cap-assisted endoscopy with conventional endoscopy.
METHODS An extensive literature search was performed (December 2021). For esophageal foreign body removal, cap-assisted endoscopy was compared to conventional endoscopy for procedure time, technical success of the procedure, time of foreign body retrieval, en bloc removal, and adverse event rate using odds ratio and mean difference.
RESULTS Six studies met the inclusion criteria (n = 1305). Higher odds of technical success (P = 0.002) and en bloc removal (P < 0.01) and lower odds of adverse events (P = 0.02) and foreign body removal time (P < 0.01) were observed with cap-assisted endoscopy as compared to conventional techniques.
CONCLUSION For esophageal foreign bodies, the technique of cap-assisted endoscopy demonstrated increased en bloc removal and technical success with decreased time and adverse events as compared to conventional techniques.
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Affiliation(s)
- Zahid Ijaz Tarar
- Department of Internal Medicine, University of Missouri, Columbia, MO 65212, United States
| | - Umer Farooq
- Department of Medicine, Loyola University, Chicago, IL 60153, United States
| | - Matthew L Bechtold
- Department of Medicine, University of Missouri - Columbia, Columbia, MO 65212, United States
| | - Yezaz A Ghouri
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65212, United States
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Lavin JM, Corboy J, Katsogridakis Y, Pham OK, Brinson D, Krug S. Electronic medical record based tools: Not a panacea in the diagnosis of coin-shaped foreign bodies. Int J Pediatr Otorhinolaryngol 2023; 164:111410. [PMID: 36529040 DOI: 10.1016/j.ijporl.2022.111410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 11/09/2022] [Accepted: 12/08/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Electronic medical record-based tools have been demonstrated to improve timeliness of x-ray order placement in patients presenting to the emergency department (ED) with coin-shaped foreign body ingestion. Similar efforts directed towards downstream processes are necessary to expedite diagnosis of an esophageal button battery. We predicted that improvement tools such as electronic medical record-based alerts and process standardization could be utilized to expedite x-ray completion. METHODS Using Plan, Do, Study, Act methodology, iterative interventions were implemented. In July 2017 a previously designed best practice advisory was linked to an automated notification page to the x-ray technician. Next, a standardized process was created where patients were gowned in triage and placed in a designated space awaiting x-ray. Workflow planning began in December 2018 and was formalized in February 2019. Time from arrival to x-ray completion was tracked for patients presenting with coin-shaped foreign body ingestion. Control charts were used to determine special cause variation. RESULTS An average of 10.1 patients (Range 4-21) presented monthly to the ED with coin-shaped foreign body ingestion. Automated pages to the x-ray technician were not associated with improved time to x-ray completion. Upon initiation of the new patient workflow, median time to x-ray completion decreased from 37.4 to 23.3 min. CONCLUSION Time to x-ray completion in children presenting to the ED with ingestion of coin-shaped foreign bodies is not improved solely through electronic notification of the imaging technologist. Efforts to standardize processes for patient intake and placement are associated with more timely completion of imaging studies. Generalizability of findings may depend on contextual elements of individual healthcare units.
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Affiliation(s)
- Jennifer M Lavin
- Division of Pediatric Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Jacqueline Corboy
- Division of Pediatric Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Yiannis Katsogridakis
- Division of Pediatric Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Oanh K Pham
- Center for Quality and Safety, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Dusty Brinson
- Division of Pediatric Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Steve Krug
- Division of Pediatric Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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9
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Chen ZC, Chen GQ, Chen XC, Zheng CY, Cao WD, Deng GH. Endoscopic extraction of a submucosal esophageal foreign body piercing into the thoracic aorta: A case report. World J Clin Cases 2022; 10:2484-2490. [PMID: 35434050 PMCID: PMC8968600 DOI: 10.12998/wjcc.v10.i8.2484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/17/2021] [Accepted: 01/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Aorto-esophageal injury is a rare but life-threatening complication of esophageal foreign bodies, which typically requires open surgery. The best way to treat patients with this condition remains unclear. To date, few reports have described an aortic wall directly penetrated by a sharp foreign body. Here, we present a rare case of a fishbone completely embedded in the esophageal muscularis propria and directly piercing the aorta, which was successfully treated by endoscopy and thoracic endovascular aortic repair (TEVAR).
CASE SUMMARY We report the case of a 71-year-old man with a 1-d history of retrosternal pain after eating fish. No abnormal findings were observed by the emergency esophagoscopy. Computed tomography showed a fishbone that had completely pierced through the esophageal mucosa and into the aorta. The patient refused to undergo surgery for personal reasons and was discharged. Five days after the onset of illness, he was readmitted to our hospital. Endoscopy examination showed a nodule with a smooth surface in the middle of the esophagus. Endoscopic ultrasonography confirmed a fishbone under the nodule. After performing TEVAR, we incised the esophageal mucosa under an endoscope and successfully removed the fishbone. The patient has remained in good condition for 1 year.
CONCLUSION Incising the esophageal wall under endoscope and extracting a foreign body after TEVAR may be a feasible option for cases such as ours.
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Affiliation(s)
- Zhi-Cao Chen
- Department of Gastroenterology, Affiliated Dongguan Hospital, Southern Medical University, Dongguan 523000, Guangdong Province, China
| | - Gui-Quan Chen
- Department of Gastroenterology, Affiliated Dongguan Hospital, Southern Medical University, Dongguan 523000, Guangdong Province, China
| | - Xiao-Chun Chen
- Department of Gastroenterology, Affiliated Dongguan Hospital, Southern Medical University, Dongguan 523000, Guangdong Province, China
| | - Chang-Ye Zheng
- Department of Radiology, Affiliated Dongguan Hospital, Southern Medical University, Dongguan 523000, Guangdong Province, China
| | - Wei-Dong Cao
- Department of Cardiovascular Surgery, Affiliated Dongguan Hospital, Southern Medical University, Dongguan 523000, Guangdong Province, China
| | - Gang-Hao Deng
- Department of Cardiovascular Surgery, Affiliated Dongguan Hospital, Southern Medical University, Dongguan 523000, Guangdong Province, China
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10
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Wang LP, Zhou ZY, Huang XP, Bai YJ, Shi HX, Sheng D. Neck and mediastinal hematoma caused by a foreign body in the esophagus with diagnostic difficulties: A case report. World J Clin Cases 2022; 10:1961-1965. [PMID: 35317134 PMCID: PMC8891789 DOI: 10.12998/wjcc.v10.i6.1961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 11/16/2021] [Accepted: 01/12/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Esophageal foreign body (FB) is a common clinical emergency. Clinically, computed tomography (CT) scans are important in the diagnosis of FBs in the esophagus. Here, we report a case of esophageal perforation and cervical hematoma, caused by a FB, whose uniqueness made rapid diagnosis difficult.
CASE SUMMARY A 42-year-old man was transferred to our hospital with esophageal perforation, which was accompanied by cervical and mediastinal hematoma. CT scans only revealed a black shadow, approximately 2.5 cm in diameter, in the upper esophagus. After multidisciplinary discussion, he was quickly subjected to mediastinal hematoma resection, peripheral nerve compression release, esophageal FB removal and esophagectomy. Eventually, we removed a small crab with a pointed tip from his esophagus.
CONCLUSION This was an unusual case of occurrence of sharp polygonal esophageal FBs caused by a small crab. Rapid diagnosis of this FB was difficult, mainly due to its translucent nature. Occurrence of sharp FBs, with cavities that sometimes only appear as black shadows on CT scans, can easily be mistaken for esophageal lumens. More attention should be paid to such sharp polygonal FBs.
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Affiliation(s)
- Li-Ping Wang
- Department of Emergency and Trauma Center, The International Medical Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Zhi-Ying Zhou
- Department of Emergency and Trauma Center, The International Medical Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Xiao-Ping Huang
- Department of Emergency and Trauma Center, The International Medical Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Yun-Juan Bai
- Department of Emergency and Trauma Center, The International Medical Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Hai-Xia Shi
- Department of Emergency and Trauma Center, The International Medical Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Di Sheng
- Department of Emergency and Trauma Center, The International Medical Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
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Tanaka Y, Sato Y, Ohno S, Endo M, Suetsugu T, Okumura N, Matsuhashi N, Takahashi T, Yoshida K. A possible indicator for removal of a large foreign body from the esophagus via a cervical approach: a case report with literature review. Clin J Gastroenterol 2022; 15:333-338. [PMID: 35001358 DOI: 10.1007/s12328-022-01589-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 01/01/2022] [Indexed: 10/19/2022]
Abstract
Foreign body intake in adults is more common among people with mental illness. Edentulous adults are at increased risk for foreign body ingestion, including of dentures. We experienced a patient who aspirated a large denture that we removed via a cervical surgical approach. A 72-year-old woman presented complaining of chest discomfort. Her medical history revealed that she suffered from schizophrenia and deafness. She had previously visited another hospital for possible loss of her denture. Chest discomfort and pain began the next day. Computed tomography showed the accidentally swallowed denture in her esophagus. Upper gastroendoscopy was attempted to remove the denture via endoscopic forceps, but it was too large to be removed and was strongly stuck. As it was difficult to perform open right thoracotomy due to left pneumonia and there was no perforation or mediastinitis, we decided to remove the denture via a left neck skin incision under general anesthesia. The denture was located in a gap between the aortic arch and vertebral body. The denture was grasped with pean forceps and extracted. The patient was discharged from hospital 18 days postoperatively. This case suggests how high a foreign body in the esophagus can be reached from a cervical incision.
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Affiliation(s)
- Yoshihiro Tanaka
- Department of Gastroenterology, Graduate School of Medicine, Gifu University School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan.
| | - Yuta Sato
- Department of Gastroenterology, Graduate School of Medicine, Gifu University School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Shinya Ohno
- Department of Gastroenterology, Graduate School of Medicine, Gifu University School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Masahide Endo
- Department of Gastroenterology, Graduate School of Medicine, Gifu University School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Tomonari Suetsugu
- Department of Gastroenterology, Graduate School of Medicine, Gifu University School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Naoki Okumura
- Department of Gastroenterology, Graduate School of Medicine, Gifu University School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Nobuhisa Matsuhashi
- Department of Gastroenterology, Graduate School of Medicine, Gifu University School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Takao Takahashi
- Department of Gastroenterology, Graduate School of Medicine, Gifu University School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Kazuhiro Yoshida
- Department of Gastroenterology, Graduate School of Medicine, Gifu University School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
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Yonemoto S, Uesato M, Aoyama H, Maruyama T, Urahama R, Suito H, Yamaguchi Y, Kato M, Matsubara H. A double-scope technique enabled a patient with an esophageal plastic fork foreign body to avoid surgery: a case report and review of the literature. Clin J Gastroenterol 2021; 15:66-70. [PMID: 34741229 DOI: 10.1007/s12328-021-01549-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/27/2021] [Indexed: 11/28/2022]
Abstract
Foreign body ingestion is a common problem, and endoscopic removal is often performed with ancillary equipment. However, long, sharp foreign bodies are much more difficult to remove endoscopically than other objects and require emergent surgery. A 68-year-old man with a history of distal gastrectomy accidentally swallowed a plastic fork. He complained of chest pain at the visit. The plastic fork was located between the thoracic esophagus and remnant stomach. Endoscopic removal of the plastic fork was considered difficult, and surgery was deemed necessary. However, we were able to avoid surgery to remove the object using two endoscopes with hoods and a polypectomy snare. The first endoscope covered the sharp edge with a hood, and the snare grasped the neck of the plastic fork. The second endoscope covered the remaining sharp tip. A single operator held the two endoscopes and the snare and pulled them out together. This new double-scope technique is simple and useful for removing long, sharp foreign bodies, such as forks, from the esophagus.
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Affiliation(s)
- Shohei Yonemoto
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8677, Japan
| | - Masaya Uesato
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8677, Japan.
| | - Hiromichi Aoyama
- Japan Community Healthcare Organization Chiba-Hospital, Chiba, 260-8710, Japan
| | - Tetsuro Maruyama
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8677, Japan
| | - Ryuma Urahama
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8677, Japan
| | - Hiroshi Suito
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8677, Japan
| | - Yukiko Yamaguchi
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8677, Japan
| | - Manami Kato
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8677, Japan
| | - Hisahiro Matsubara
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8677, Japan
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Pan W, Lin LJ, Meng ZW, Cai XR, Chen YL. Hepatic abscess caused by esophageal foreign body misdiagnosed as cystadenocarcinoma by magnetic resonance imaging: A case report. World J Clin Cases 2021; 9:6781-6788. [PMID: 34447825 PMCID: PMC8362509 DOI: 10.12998/wjcc.v9.i23.6781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/11/2021] [Accepted: 07/05/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Foreign bodies stuck in the throat and esophagus can be discharged through the digestive tract. Esophageal-lodged foreign bodies can cause secondary injury or detrimental response, with hepatic abscess being one such, albeit rare, outcome. Review and discussion of the few case reports on such instances will help to improve the overall understanding of such conditions and aid in differential diagnosis to improve patient outcome.
CASE SUMMARY A 51-year-old female patient with pre-existing diabetes visited our hospital following a 15-d experience of chills and fever. Both plain and enhanced magnetic resonance imaging and color Doppler ultrasound examination of the liver and gallbladder revealed a space-occupying lesion in the caudate lobe of the liver (7.8 cm × 6.0 cm × 5.0 cm). Initially, a malignant tumor was suspected, but differential diagnosis was unable to exclude the possibility of hepatic abscess. Conservative anti-infection therapy produced a less than ideal outcome. Additional examination by hepatobiliary imaging with computed tomography suggested a foreign body present in the upper abdomen and hepatic abscess, and subsequent endoscopy revealed a sinus tract in the anterior wall of the duodenal bulb. Therefore, surgery was performed to remove the object (fishbone) and drain the abscess. After a 2-wk uneventful recovery, the patient was discharged. The final diagnosis was foreign body-induced hepatic abscess of the caudate lobe.
CONCLUSION Differential diagnosis is important for hepatic masses, and systematic examination and physician awareness can aid in diagnosing and curing such rare conditions.
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Affiliation(s)
- Wei Pan
- Department of Hepatobiliary Surgery and Fujian Institute of Hepatobiliary Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
- Fujian Medical University Cancer Center, Fuzhou 350001, Fujian Province, China
| | - Li-Jing Lin
- Department of Endocrinology, Union Hospital, Fujian Institute of Endocrinology, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
| | - Ze-Wu Meng
- Department of Hepatobiliary Surgery and Fujian Institute of Hepatobiliary Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
- Fujian Medical University Cancer Center, Fuzhou 350001, Fujian Province, China
| | - Xin-Ran Cai
- Department of Hepatobiliary Surgery and Fujian Institute of Hepatobiliary Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
- Fujian Medical University Cancer Center, Fuzhou 350001, Fujian Province, China
| | - Yan-Ling Chen
- Department of Hepatobiliary Surgery and Fujian Institute of Hepatobiliary Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
- Fujian Medical University Cancer Center, Fuzhou 350001, Fujian Province, China
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Syahputra DA, Kusmayadi DD, Indriasari V, Kusumowidagdo F. Unusual esophageal foreign body in neonates: A case report. Int J Surg Case Rep 2021; 85:106236. [PMID: 34333255 PMCID: PMC8346634 DOI: 10.1016/j.ijscr.2021.106236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 07/22/2021] [Accepted: 07/22/2021] [Indexed: 02/05/2023] Open
Abstract
Introduction and importance Esophageal foreign body mostly occurs in children aged 6 months to 5 years old. In neonates (babies less than 28 days old), such report is extremely rare. In this case, we report the first esophageal foreign body in neonates without any symptoms. Case presentation A 28-day-old baby boy, with normal body weight, from a low socio-economic status family, came to us with a history of ingested foreign body. No sign of unconsciousness, excessive saliva, dysphagia, and respiratory distress. The chest X-ray revealed a radiopaque foreign body in the upper third of the esophagus. The patient underwent extraction of the foreign body using a flexible endoscope under general anesthesia. We found a 1.9 cm in diameter pendant with no sign of bleeding nor inflammation in the esophageal lumen. After the foreign body removal, the patient is in good condition and recovered uneventfully. Clinical discussion Foreign body in children under 6 months old is very rare. A high index of suspicion for foreign body ingestion must be considered in unattended children from lower socio-economic status, primarily if witness statements are present and confirmed with radiological examination. Most common impaction site is at the level of the cricopharyngeus muscle. Currently, flexible endoscopy is the standard for foreign body removal in children. Conclusion High index suspiciousness, witness statements and radiological examination are the important points in diagnosing ingested foreign body in neonates. Clinicians are required to provide education to parents to supervise their children when playing together. Esophageal foreign body extremely rare in neonates Most common without symptoms due to the diet consists of full fluids Witness statements and radiological examination are an important point in diagnosis. The impaction of foreign body is strong indication for foreign body removal. Flexible endoscopy is the standard for foreign body removal in children.
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Affiliation(s)
- Dian Adi Syahputra
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Syiah Kuala University/Dr. Zainoel Abidin Hospital, Banda Aceh, Aceh, Indonesia; Pediatric Urogenital Fellowship, Pediatric Surgery Division, Faculty of Medicine, Padjadjaran University/Hasan Sadikin Hospital, West Java, Indonesia.
| | - Dikki Drajat Kusmayadi
- Pediatric Surgery Digestive Consultant, Pediatric Surgery Division, Faculty of Medicine, Padjadjaran University/Hasan Sadikin Hospital, West Java, Indonesia
| | - Vita Indriasari
- Pediatric Surgery Urogenital Consultant, Pediatric Surgery Division, Faculty of Medicine, Padjadjaran University/Hasan Sadikin Hospital, West Java, Indonesia
| | - Fransiska Kusumowidagdo
- Pediatric Urogenital Fellowship, Pediatric Surgery Division, Faculty of Medicine, Padjadjaran University/Hasan Sadikin Hospital, West Java, Indonesia; Pediatric Surgery Department, Faculty of Medicine, Airlangga University, Soetomo Hospital, East Java, Indonesia
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Qiu Y, Xu S, Wang Y, Chen E. Migration of ingested sharp foreign body into the bronchus: a case report and review of the literature. BMC Pulm Med 2021; 21:90. [PMID: 33731031 PMCID: PMC7968162 DOI: 10.1186/s12890-021-01458-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 03/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background Foreign body ingestion is a common emergence in gastroenterology. Foreign bodies are most likely to be embedded in the esophagus. The sharp ones may penetrate the esophageal wall and lead to serious complications. Case presentation A 72-year-old Chinese female was admitted to our hospital with a 4-day history of retrosternal pain and a growing cough after eating fish. Chest computed tomography scan indicated that a high-density foreign body (a fish bone) penetrated through the esophageal wall and inserted into the left main bronchus. First, we used a rigid esophagoscope to explore the esophagus under general anesthesia. However, the foreign body was invisible in the side of the esophagus. Then, the fiberoptic bronchoscopy was performed. We divided the fish bone, which traversed the left main bronchus, into two segments under holmium laser and removed the foreign body successfully. The operation time was short and there were no complications. The patient was discharged 1 week postoperatively and was symptom free even under a liquid diet. Conclusions There are several challenges in the management of this rare condition. We applied the technique of interventional bronchoscopy to the management of esophageal foreign body flexibly in an emergency. A surgery was avoided, which was more invasive and costly.
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Affiliation(s)
- Yuanhua Qiu
- Department of Respiratory and Critical Care Medicine, Regional Medical Center for National Institute of Respiratory Disease, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Shan Xu
- Department of Respiratory and Critical Care Medicine, Regional Medical Center for National Institute of Respiratory Disease, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Yafang Wang
- Department of Respiratory and Critical Care Medicine, Regional Medical Center for National Institute of Respiratory Disease, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Enguo Chen
- Department of Respiratory and Critical Care Medicine, Regional Medical Center for National Institute of Respiratory Disease, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
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Bertlich M, Ihler F, Sommerlath Sohns JM, Canis M, Weiss BG. From the Bottlecap to the Bottleneck: Frequent Esophageal Impaction of Bottlecaps Among Young Males in a Small University Town. Dysphagia 2021. [PMID: 33580816 DOI: 10.1007/s00455-021-10263-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/27/2021] [Indexed: 10/28/2022]
Abstract
There have been few reports of ingestion of bottlecaps worldwide. However, all of these seemed to be unlikely accidental ingestions with a comic side effect. In contrast to this, the authors of this study found an accumulation of bottlecap ingestions in a small university town. Hence, we conducted a study to investigate the nature of these ingestions. We conducted a retrospective cohort study in a tertiary referral center in a small German university town (Göttingen). All patients that were admitted for esophageal foreign bodies were screened for accidental ingestion of bottlecaps and included in the study at hand. Overall, there were 14 cases of bottlecap ingestion within 12 years. Patients were exclusively male, average age was 23.0 ± 4.2 years, ranging from 18.3 to 35.6 years. In 13 out of 14 cases, association to a fraternity was found. Young men, particularly those belonging to a fraternity, should be beware of bottlecap ingestion when consuming beer in risky rituals in small university towns. Alternatively, competitive beer drinking may generally be avoided.
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Davoodi F, Valizadeh Y, Raisi A, Mozaffari N, Gohardehi K. Esophageal foreign body removal through gastrotomy using a covault hook in a female dog: A case report. Vet Res Forum 2021; 12:387-389. [PMID: 34815853 PMCID: PMC8576149 DOI: 10.30466/vrf.2020.128301.2967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/03/2020] [Indexed: 11/23/2022]
Abstract
One of the most critical emergencies in dogs is esophageal foreign bodies. The most important foreign body reported in the esophagus is bone; however, there are also reports of fish hooks lodged in the esophagus. This case report describes the history, clinical signs, radiographic findings and surgical management of an esophageal foreign body due to a single-barbed fish hook in a 4-month-old Siberian Husky female dog with regurgitation, pain, anorexia and lethargy. In this case, plain radiography was taken to determine the type and location of the foreign body and it was confirmed that a single-barbed fish hook was lodged in the heart base of thorax. Depending on the type of foreign body, penetrable or non-penetrable as well as the location, a variety of methods including endoscopy, fluoroscopy, and surgery are used for its removal. For treatment, for the first time, a covault hook was utilized to remove the foreign body via gastrotomy. Case follow-up during two weeks showed no postoperative complications and the patient was healthy.
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Affiliation(s)
- Farshid Davoodi
- DVM Graduate, Faculty of Veterinary Medicine, Lorestan University, Khorramabad, Iran;
| | - Yasin Valizadeh
- DVM Graduate, Faculty of Veterinary Medicine, Lorestan University, Khorramabad, Iran;
| | - Abbas Raisi
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Lorestan University, Khorramabad, Iran.,Correspondence Abbas Raisi. DVM, DVSc, Department of Clinical Sciences, Faculty of Veterinary Medicine, Lorestan University, Khorramabad, Iran. E-mail:
| | - Nima Mozaffari
- DVM Graduate, Faculty of Veterinary Medicine, Lorestan University, Khorramabad, Iran;
| | - Karin Gohardehi
- DVM Graduate, Faculty of Veterinary Medicine, Lorestan University, Khorramabad, Iran;
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Abstract
Background Aortoesophageal fistula (AEF) caused by an esophageal foreign body is a life-threatening crisis, with rapid progress and high mortality. The first case of AEF was reported in 1818, but the first successfully managed case was not until 1980. Although there have been some reports on this condition, in most cases, the aorta was invaded and corroded due to its adjacent relationship with the esophagus and subsequent mediastinitis. To date, few reports have described an aortic wall directly penetrated by a sharp foreign body, likely because this type of injury is extremely rare and most patients cannot receive timely treatment. Here, we present a rare case of a fish bone that directly pierced the aorta via the esophagus. Case presentation A 31-year-old female experienced poststernum swallowing pain after eating a meal of fish. Gastroscope showed a fishbone-like foreign body had penetrated the esophagus wall. Computed tomography revealed that the foreign body had directly pierced the aorta to form an AEF. Surgery was successfully performed to repair the aorta and esophagus. The postoperation and follow-up was uneventful. Conclusions For the treatment of foreign bodies in the esophagus, we should be alert of the possibility of AEFs. The effective management of AEFs requires early diagnosis and intervention, as well as long-term treatment and follow-up, which still has a long way to go.
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Affiliation(s)
- Daming Jiang
- Department of Cardiovascular Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, 88 JieFang Road, Hangzhou, P.R. China, 310009.
| | - Yi Lu
- Department of Cardiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yigong Zhang
- Department of Cardiovascular Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, 88 JieFang Road, Hangzhou, P.R. China, 310009
| | - Zhanglong Hu
- Department of Cardiovascular Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, 88 JieFang Road, Hangzhou, P.R. China, 310009
| | - Haifeng Cheng
- Department of Cardiovascular Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, 88 JieFang Road, Hangzhou, P.R. China, 310009
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John A, Chowdhury SD, Kurien RT, David D, Dutta AK, Simon EG, Abraham V, Joseph AJ, Samarasam I. Self-expanding metal stent in esophageal perforations and anastomotic leaks. Indian J Gastroenterol 2020; 39:445-449. [PMID: 33001339 DOI: 10.1007/s12664-020-01078-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 07/15/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Placement of self-expanding metal stents (SEMS) has emerged as a minimally invasive treatment option for esophageal perforation and leaks. The aim of our study was to assess the role of SEMS for the management of benign esophageal diseases such as perforations and anastomotic leaks. METHODS All patients (n = 26) who underwent SEMS placement for esophageal perforation and anastomotic leaks between May 2012 and February 2019 were included. Data were analyzed in relation to the indications, type of stent used, complications, and outcomes. RESULTS Indications for stent placement included anastomotic leaks 65% (n = 17) and perforations 35% (n = 9). Fully covered SEMS (FCSEMS) was placed in 25 patients, and in 1, partially covered SEMS (PCSEMS) was placed. Stent placement was successful in all the patients (n = 26). Four patients did not report for follow-up after stenting. Among the patients on follow-up, 91% (20/22) had healing of the mucosal defect. Stent-related complications were seen in 5 (23%) patients and included stent migration [3], reactive hyperplasia [1] and stricture [1]. CONCLUSION Covered stent placement for a duration of 8 weeks is technically safe and clinically effective as a first-line procedure for bridging and healing benign esophageal perforation and leaks.
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Affiliation(s)
- Anoop John
- Department of Gastroenterology, Christian Medical College, Vellore 632 004, India
| | | | - Reuben Thomas Kurien
- Department of Gastroenterology, Christian Medical College, Vellore 632 004, India
| | - Deepu David
- Department of Gastroenterology, Christian Medical College, Vellore 632 004, India
| | - Amit Kumar Dutta
- Department of Gastroenterology, Christian Medical College, Vellore 632 004, India
| | - Ebby George Simon
- Department of Gastroenterology, Christian Medical College, Vellore 632 004, India
| | - Vijay Abraham
- Upper GI Surgery Unit, Division of Surgery, Christian Medical College, Vellore 632 004, India
| | - A J Joseph
- Department of Gastroenterology, Christian Medical College, Vellore 632 004, India
| | - Inian Samarasam
- Upper GI Surgery Unit, Division of Surgery, Christian Medical College, Vellore 632 004, India
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20
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Whelan R, Shaffer A, Dohar JE. Button battery versus stacked coin ingestion: A conundrum for radiographic diagnosis. Int J Pediatr Otorhinolaryngol 2019; 126:109627. [PMID: 31404782 PMCID: PMC6825552 DOI: 10.1016/j.ijporl.2019.109627] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 08/02/2019] [Accepted: 08/03/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Given the potential for devastating complications associated with esophageal impaction of a button battery, there is a need to distinguish between a button battery and look-alike stacked coins at the time of presentation. Given there have been no studies analyzing differences in radiographic density between these two entities, the study objective was to determine if a difference exists between esophageal coin and button battery radiographic density on plain radiograph and to describe the operative and treatment course following these two distinct entities of ingestion. METHODS Retrospective case series following button battery or stacked coin ingestion in a tertiary care pediatric hospital from 2003 to present. Radiographic density of each button battery and stacked coin was calculated by dividing the foreign body radiographic density by the mean density of two background radiographic sections. Radiographic density of coins versus batteries was compared using t-tests. RESULTS There were 22 patients identified with button battery ingestion and 47 with stacked coins. Median (range) radiographic density of button batteries on anteroposterior view was 1.16 (0.37-2.19) x background compared to 1.13 (0.09-2.65) x background of stacked coins, p = 0.198. There was similarly no statistically significant difference in lateral views, p = 0.622. CONCLUSION Our study suggests that radiographic density measured on diagnostic x-ray does not prove a reliable adjunctive measure to distinguish an innocuous stacked coin ingestion from the far more ominous button battery and highlights the need for prompt operative evaluation for any suspected button battery ingestion.
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Affiliation(s)
- Rachel Whelan
- Children's Hospital of Pittsburgh of UPMC, Department of Otolaryngology, Pittsburgh, PA, USA.
| | - Amber Shaffer
- Children's Hospital of Pittsburgh of UPMC, Department of Otolaryngology, Pittsburgh, PA, USA
| | - Joseph E Dohar
- Children's Hospital of Pittsburgh of UPMC, Department of Otolaryngology, Pittsburgh, PA, USA
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Abstract
OBJECTIVE Esophageal Foreign Body (FB) impaction represents a major challenge for healthcare providers. Aim of this systematic review was to analyse the current literature evidence on prevalence, presentation, treatment, and outcomes of impacted esophageal FB. MATERIALS AND METHODS Literature search was conducted between 2000 and 30th June 2018 according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. RESULTS Sixty-one studies matched the inclusion criteria. The total number of included patients was 13,092. The cervical esophagus was the most frequent impaction site (67%) and sharp-pointed objects were the most common FB (38.1%). Retrosternal pain (78%), dysphagia (48%), and odynophagia (43.4%) were the most common symptoms. A flexible or rigid endoscopic approach was adopted in 65.1% and 16.8% of patients, respectively. Overall, 17.8% of patients had a complication related to the impacted esophageal FB or to the endoscopic manoeuvers. A surgical approach was required in 3.4% of patients. The overall mortality was 0.85%. CONCLUSIONS Surgery is the upfront treatment in patients with esophageal perforation or endoscopically irretrievable esophageal FB. A minimally invasive approach can be adopted in selected patients. Effective prevention of FB impaction should focus on accurate diagnostic work-up to search for an underlying motility disorder after a first episode of esophageal impaction, even if transient and self-resolving.
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Affiliation(s)
- Alberto Aiolfi
- a Department of Biomedical Science for Health, Division of General Surgery IRCCS Policlinico San Donato , University of Milan , Milan , Italy
| | - Davide Ferrari
- a Department of Biomedical Science for Health, Division of General Surgery IRCCS Policlinico San Donato , University of Milan , Milan , Italy
| | - Carlo Galdino Riva
- a Department of Biomedical Science for Health, Division of General Surgery IRCCS Policlinico San Donato , University of Milan , Milan , Italy
| | - Francesco Toti
- a Department of Biomedical Science for Health, Division of General Surgery IRCCS Policlinico San Donato , University of Milan , Milan , Italy
| | - Gianluca Bonitta
- a Department of Biomedical Science for Health, Division of General Surgery IRCCS Policlinico San Donato , University of Milan , Milan , Italy
| | - Luigi Bonavina
- a Department of Biomedical Science for Health, Division of General Surgery IRCCS Policlinico San Donato , University of Milan , Milan , Italy
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Ferrari D, Aiolfi A, Bonitta G, Riva CG, Rausa E, Siboni S, Toti F, Bonavina L. Flexible versus rigid endoscopy in the management of esophageal foreign body impaction: systematic review and meta-analysis. World J Emerg Surg 2018; 13:42. [PMID: 30214470 PMCID: PMC6134522 DOI: 10.1186/s13017-018-0203-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/03/2018] [Indexed: 02/06/2023] Open
Abstract
Background Foreign body (FB) impaction accounts for 4% of emergency endoscopies in clinical practice. Flexible endoscopy (FE) is recommended as the first-line therapeutic option because it can be performed under sedation, is cost-effective, and is well tolerated. Rigid endoscopy (RE) under general anesthesia is less used but may be advantageous in some circumstances. The aim of the study was to compare the efficacy and safety of FE and RE in esophageal FB removal. Methods PubMed, MEDLINE, Embase, and Cochrane databases were consulted matching the terms "Rigid endoscopy AND Flexible endoscopy AND foreign bod*". Pooled effect measures were calculated using an inverse-variance weighted or Mantel-Haenszel in random effects meta-analysis. Heterogeneity was evaluated using I2 index and Cochrane Q test. Results Five observational cohort studies, published between 1993 and 2015, matched the inclusion criteria. One thousand four hundred and two patients were included; FE was performed in 736 patients and RE in 666. Overall, 101 (7.2%) complications occurred. The most frequent complications were mucosal erosion (26.7%), mucosal edema (18.8%), and iatrogenic esophageal perforations (10.9%). Compared to FE, the estimated RE pooled success OR was 1.00 (95% CI 0.48-2.06; p = 1.00). The pooled OR of iatrogenic perforation, other complications, and overall complications were 2.87 (95% CI 0.96-8.61; p = 0.06), 1.09 (95% CI 0.38-3.18; p = 0.87), and 1.50 (95% CI 0.53-4.25; p = 0.44), respectively. There was no mortality. Conclusions FE and RE are equally safe and effective for the removal of esophageal FB. To provide a tailored or crossover approach, patients should be managed in multidisciplinary centers where expertise in RE is also available. Formal training and certification in RE should probably be re-evaluated.
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Affiliation(s)
- Davide Ferrari
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Piazza E. Malan, 1, 20097 San Donato Milanese, Milan, Italy
| | - Alberto Aiolfi
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Piazza E. Malan, 1, 20097 San Donato Milanese, Milan, Italy
| | - Gianluca Bonitta
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Piazza E. Malan, 1, 20097 San Donato Milanese, Milan, Italy
| | - Carlo Galdino Riva
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Piazza E. Malan, 1, 20097 San Donato Milanese, Milan, Italy
| | - Emanuele Rausa
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Piazza E. Malan, 1, 20097 San Donato Milanese, Milan, Italy
| | - Stefano Siboni
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Piazza E. Malan, 1, 20097 San Donato Milanese, Milan, Italy
| | - Francesco Toti
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Piazza E. Malan, 1, 20097 San Donato Milanese, Milan, Italy
| | - Luigi Bonavina
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Piazza E. Malan, 1, 20097 San Donato Milanese, Milan, Italy
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Wang J, Wu WB, Chen L, Zhu Q. Video-mediastinoscopy assisted fish bone extraction and superior Medistinal abscess debridement. J Cardiothorac Surg 2018; 13:38. [PMID: 29764457 PMCID: PMC5952655 DOI: 10.1186/s13019-018-0732-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 05/09/2018] [Indexed: 12/19/2022] Open
Abstract
Background Mediastinum abscess caused by sharp esophageal foreign body perforation usually needs surgical treatment, and the surgical procedures vary according to size of perforation and scope of abscess, etc. For special case with small esophageal mucosal crevasse and focal abscess confined to mediastinum, minimally invasive surgery with guidance of video-mediastinoscopy would be an alternative method, however, application of video-mediastinoscopy in this life-threatening situation was rarely reported. Case presentation One patient with detention of fish bone stuck in the esophagus developed systemic inflammatory response syndrome. Computed tomography results revealed that two high-density foreign bodies migrated extraluminally and caused abscess confined in the mediastinum. Multidisplinary collaborative efforts of anesthesiology, gastroenterology and thoracic surgery were made to optimize the therapeutic process. By taking advantages of wide working channel and better exposure of video-mediastinoscopy, two sharp fish bones were removed with minimal risk of injuring adjacent important tissues, furthermore, complete debridement of the abscess and precise drainage tube indwelling was achieved simultaneously. Postoperative comprehensive therapy including anti-infection and nutrition support guaranteed a smooth transition of perioperative period. Conclusion This is the first report on application of video-mediastinoscopy in removing two fish bones that migrated extraluminally and debridement of the abscess caused by esophagus perforation with minimal injury risk, which offer a safe and effective minimal invasive method for specific cases.
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Affiliation(s)
- Jun Wang
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wei Bing Wu
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Liang Chen
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Quan Zhu
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Ebrahim A, Still S, Schwartz G. Thoracoscopic management of a mediastinal abscess caused by extra-esophageal migration of a metal brush bristle. Proc (Bayl Univ Med Cent) 2018; 31:192-193. [PMID: 29706816 DOI: 10.1080/08998280.2017.1416240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 11/13/2017] [Accepted: 11/16/2017] [Indexed: 01/02/2023] Open
Abstract
Foreign body perforations of the esophagus are infrequent events yet have the potential to cause significant morbidity and mortality. The clinical consequences of esophageal perforation by a foreign body are dependent upon the severity of infectious sequelae and damage to surrounding structures by the foreign object itself, as detailed in previous published reports. We describe the thoracoscopic management of a mediastinal abscess caused by a foreign body perforation in a patient with an intact esophagus.
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Affiliation(s)
- Ahmed Ebrahim
- Texas A&M Health Science Center, College of Medicine, Dallas, Texas
| | - Sasha Still
- Department of General Surgery, Baylor University Medical Center, Dallas, Texas
| | - Gary Schwartz
- Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, Texas
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Hur K, Angajala V, Maceri D, Hochstim C. Geographic health disparities in the Los Angeles pediatric esophageal foreign body population. Int J Pediatr Otorhinolaryngol 2018; 106:85-90. [PMID: 29447899 DOI: 10.1016/j.ijporl.2018.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 01/07/2018] [Accepted: 01/10/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess geographical sociodemographic differences in the pediatric esophageal foreign body population of Los Angeles. METHODS We retrospectively reviewed the medical records of 128 consecutive pediatric patients at Children's Hospital Los Angeles (CHLA) from 2014 to 2017 with a diagnosis of a retained foreign body in the esophagus removed by rigid or flexible esophagoscopy. Sociodemographic information including zip code of residence was extracted and analyzed with Chi-square, Fisher's exact test, and multivariable logistic regression. RESULTS The average age of patients with a retained esophageal foreign body in this study was 2.5 years old, 52.3% were male, 91.4% had no past medical history, 53.1% were Hispanic, 82.0% had public health insurance, and 63.3% were transfers from an outside hospital. The most common foreign body removed was a coin. There were no significant differences in gender, race, type of health insurance, or income between patients that lived within 10 miles of CHLA versus farther than 10 miles. On multivariable analysis, zip codes with a high volume of esophageal foreign bodies were more likely to be lower income neighborhoods. Gender, race, type of health insurance, and distance from CHLA were not risk factors for zip codes with a high volume of esophageal foreign bodies. CONCLUSION Geographic areas in the greater Los Angeles community with a high volume of retained esophageal foreign bodies requiring endoscopic removal at our institution are associated with lower income neighborhoods. Further studies should be performed to better understand health disparities within the U.S. pediatric esophageal foreign body population.
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Affiliation(s)
- Kevin Hur
- Caruso Department of Otolaryngology - Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Varun Angajala
- Caruso Department of Otolaryngology - Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Dennis Maceri
- Caruso Department of Otolaryngology - Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Division of Otolaryngology - Head and Neck Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Christian Hochstim
- Caruso Department of Otolaryngology - Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Division of Otolaryngology - Head and Neck Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
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Yazaki T, Ooshima N, Ishimura N, Sato S, Kinoshita Y. [Diagnostic significance of computed tomography findings of foreign body in esophagus]. Nihon Ronen Igakkai Zasshi 2018; 55:668-674. [PMID: 30542034 DOI: 10.3143/geriatrics.55.668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
An 84-year-old male with dysphagia was referred to our hospital. Chest computed tomography (CT) showed a rectangular structure along with artificial air in the cervical esophagus. Endoscopy revealed a 'shogi' game piece in the same region shown in CT findings, which was recovered during the endoscopic procedure. From January 2006 to July 2017, we experienced a total of 84 cases of esophageal foreign bodies at our institution (49 males, 35 females; mean age 60 years). Among those cases, the most common foreign body in the esophagus was a food ball, though fish bones and pharmaceutical packaging materials have often been recovered from elderly patients. Chest CT was performed in 39 of those cases prior to an endoscopic examination, with a foreign body in the esophagus detected by CT in 37 (95%). In addition, the stopping portion, progression of inflammation, and presence of free air can be assessed with CT imaging, which provide important clinical information for a safer and faster subsequent endoscopic procedure. Recently, a report conducted outside of Japan noted that eosinophilic esophagitis (EoE) was the main cause of food stoppage in the esophagus. A second-look examination may be necessary to determine the presence of EoE causing such a foreign body blockage.
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Affiliation(s)
- Tomotaka Yazaki
- Department of Internal Medicine II, Shimane University, Faculty of Medicine
| | - Naoki Ooshima
- Department of Internal Medicine II, Shimane University, Faculty of Medicine
| | - Norihisa Ishimura
- Department of Internal Medicine II, Shimane University, Faculty of Medicine
| | - Shuichi Sato
- Department of Internal Medicine II, Shimane University, Faculty of Medicine
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Shi WS, Su ZY, Wei CY, Chen XF, Liu SS, Fu X, Liu DL, Cui GH. Clinical features and standardized diagnosis and treatment of esophageal foreign bodies. Shijie Huaren Xiaohua Zazhi 2017; 25:2721-2730. [DOI: 10.11569/wcjd.v25.i30.2721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Wen-Song Shi
- Dong-Lei Lie, Guang-Hui Cui, Department of Thoracic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, He'nan Province, China
| | - Zheng-Yan Su
- Department of Gastroenterology, General Hospital of Tianjin Medical University, Tianjin 300000, China
| | - Chuang-Ye Wei
- Dong-Lei Lie, Guang-Hui Cui, Department of Thoracic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, He'nan Province, China
| | - Xiao-Fang Chen
- Dong-Lei Lie, Guang-Hui Cui, Department of Thoracic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, He'nan Province, China
| | - Shuai-Shuai Liu
- Dong-Lei Lie, Guang-Hui Cui, Department of Thoracic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, He'nan Province, China
| | - Xiao Fu
- Dong-Lei Lie, Guang-Hui Cui, Department of Thoracic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, He'nan Province, China
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Klancnik M, Grgec M, Perković N, Ivanišević P, Poljak NK. A Foreign Body (Toothbrush) in the Esophagus of a Patient with Hiatal Hernia. Case Rep Gastroenterol 2017; 11:184-189. [PMID: 28512391 PMCID: PMC5422728 DOI: 10.1159/000464277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 02/13/2017] [Indexed: 12/29/2022] Open
Abstract
Toothbrush ingestion is rare and most commonly seen in patients with psychiatric comorbidities and in young women with a medical history of eating disorders who try to induce emesis. Long ingested objects, such as a toothbrush, cannot pass the gastrointestinal tract spontaneously and require endoscopic removal or even a surgical approach in cases of unsuccessful endoscopic removal or complication development. We present a case of a 71-year-old male with hiatal hernia without psychiatric or neurological comorbidity who accidentally ingested a toothbrush during oral hygiene routine. After X-ray confirmation, the toothbrush was removed endoscopically.
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Affiliation(s)
- Marisa Klancnik
- aClinical Department for Ear Nose and Throat, Split University Hospital Center, Split, Croatia
| | - Maja Grgec
- aClinical Department for Ear Nose and Throat, Split University Hospital Center, Split, Croatia
| | - Nikola Perković
- bClinical Department for Internal Medicine, Division of Gastroenterology, Split University Hospital Center, Split, Croatia
| | - Petar Ivanišević
- aClinical Department for Ear Nose and Throat, Split University Hospital Center, Split, Croatia
| | - Nikola Kolja Poljak
- aClinical Department for Ear Nose and Throat, Split University Hospital Center, Split, Croatia
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Abstract
BACKGROUND Esophageal foreign body retrieval is typically performed by rigid or flexible esophagoscopy. Despite evidence supporting the efficacy and safety of balloon extraction, it is rarely performed. We sought to establish the financial benefits of this minimally invasive approach. METHODS A retrospective review of 241 children with esophageal coins between 2011 and 2013 was performed. Coins were removed via endoscopy or fluoroscopic-guided balloon retrieval. Timing, symptoms, facility cost, and patient charges were compared. RESULTS Two hundred patients had attempted balloon retrieval with 80% success. Forty-one patients went directly for operative removal. Patients with respiratory difficulty (p=0.05), wheezing (p<0.01), or fever (p=0.03) were more often taken directly for endoscopic retrieval. The median cost and charges for attempted balloon extraction were $484 and $1647. The median cost and charges for primary endoscopy were $1834 and $6746. The median total cost and charges of attempted balloon extraction including ED, OR, transport, admission, and balloon retrieval were $1231 and $3539 versus $3615 and $12,204 in the primary endoscopy group (p<0.001, p<0.001). Seventeen percent of patients who underwent attempted balloon retrieval were admitted prior to removal compared to 76% who underwent primary endoscopy (p<0.001). CONCLUSIONS Fluoroscopic guided balloon extraction of esophageal coins is a financially prudent choice which shortens hospital stay. LEVEL OF EVIDENCE III. TYPE OF STUDY Retrospective treatment and economic study.
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Affiliation(s)
| | - Shiva R Reddy
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO
| | - Angela A Mundakkal
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO
| | - Shawn D St Peter
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO.
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Nasirmohtaram S, Shabani N. Esophageal Foreign Body: A Case Report of a Refractory Croup in a 20-Month-Old Boy. Iran J Otorhinolaryngol 2016; 28:435-437. [PMID: 28008396 PMCID: PMC5168577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 01/14/2016] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Foreign body ingestion is common among children and more common in boys and in children under the age of 3. It can present with a wide variety of symptoms like dysphagia and drooling or symptoms related to the upper aerodigestive tract. CASE REPORT A 20-month-old male presented with refractory croup and poor feeding since 2 weeks. Bronchoscopy and esophagoscopy was performed due to suspicious history of eating loquat. The core of the fruit was found in the esophagus. CONCLUSION Physicians should be aware of the variability of esophageal foreign body presentations to prevent serious complications due to delay in diagnosis.
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Affiliation(s)
- Sevil Nasirmohtaram
- Otorhinolaryngology Research Centre, Gilan University of Medical Sciences, Amir-almomenin Hospital, Rasht, Iran
| | - Nooshin Shabani
- Otorhinolaryngology Research Centre, Gilan University of Medical Sciences, Amir-almomenin Hospital, Rasht, Iran
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31
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Eliason MJ, Melzer JM, Winters JR, Gallagher TQ. Identifying predictive factors for long-term complications following button battery impactions: A case series and literature review. Int J Pediatr Otorhinolaryngol 2016; 87:198-202. [PMID: 27368471 DOI: 10.1016/j.ijporl.2016.06.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To complement a case series review of button battery impactions managed at our single military tertiary care center with a thorough literature review of laboratory research and clinical cases to develop a protocol to optimize patient care. Specifically, to identify predictive factors of long-term complications which can be used by the pediatric otolaryngologist to guide patient management after button battery impactions. METHODS A retrospective review of the Department of Defense's electronic medical record systems was conducted to identify patients with button battery ingestions and then characterize their treatment course. A thorough literature review complemented the lessons learned to identify potentially predictive clinical measures for long-term complications. RESULTS Eight patients were identified as being treated for button battery impaction in the aerodigestive tract with two sustaining long-term complications. The median age of the patients treated was 33 months old and the median estimated time of impaction in the aerodigestive tract prior to removal was 10.5 h. Time of impaction, anatomic direction of the battery's negative pole, and identifying specific battery parameters were identified as factors that may be employed to predict sequelae. CONCLUSION Based on case reviews, advancements in battery manufacturing, and laboratory research, there are distinct clinical factors that should be assessed at the time of initial therapy to guide follow-up management to minimize potential catastrophic sequelae of button battery ingestion.
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Affiliation(s)
- Michael J Eliason
- Naval Medical Center Portsmouth, Department of Otolaryngology, 620 John Paul Jones Circle, Portsmouth, VA 23708, USA.
| | - Jonathan M Melzer
- Naval Medical Center Portsmouth, Department of Otolaryngology, 620 John Paul Jones Circle, Portsmouth, VA 23708, USA
| | - Jessica R Winters
- Naval Medical Center Portsmouth, Department of Otolaryngology, 620 John Paul Jones Circle, Portsmouth, VA 23708, USA
| | - Thomas Q Gallagher
- Naval Medical Center Portsmouth, Department of Otolaryngology, 620 John Paul Jones Circle, Portsmouth, VA 23708, USA
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32
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Skaff C, Al Awadhi H, Habib Z, Al-Dekhail W. Intramural esophageal foreign body in a child. Int J Pediatr Adolesc Med 2016; 3:34-37. [PMID: 30805465 PMCID: PMC6372402 DOI: 10.1016/j.ijpam.2015.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 11/13/2015] [Accepted: 11/19/2015] [Indexed: 11/26/2022]
Abstract
Foreign body ingestion is a common problem in the pediatric population. The majority of cases occur between 6 months and 3 years of age. Major complications, including bowel perforation and obstruction, have been reported. Forty percent of ingested foreign bodies are unwitnessed, and in fact, many are asymptomatic. We report the case of a 2-year-old girl who was referred to King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia (KFSH&RC) with suspected congenital esophageal stenosis. Upon investigation, she was diagnosed with intramural esophageal foreign body.
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Affiliation(s)
- Chahdah Skaff
- Department of Pediatrics, King Faisal Specialist Hospital & Research Centre, Saudi Arabia
| | - Haifa Al Awadhi
- Pediatric Gastroenterology Department, King Faisal Specialist Hospital and Research Centre, Saudi Arabia
| | - Zakaria Habib
- Pediatric Surgery Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Wajeeh Al-Dekhail
- Pediatric Gastroenterology Department, King Faisal Specialist Hospital and Research Centre, Saudi Arabia
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Shew M, Jiang Z, Bruegger D, Arganbright J. Migrated esophageal foreign body presents as acute onset dysphagia years later: A case report. Int J Pediatr Otorhinolaryngol 2015; 79:2460-2. [PMID: 26541295 DOI: 10.1016/j.ijporl.2015.10.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 10/13/2015] [Accepted: 10/14/2015] [Indexed: 11/28/2022]
Abstract
Ingested esophageal foreign bodies are commonly seen in the pediatric population. Rarely do they perforate and migrate through neck fascial planes asymptomatically. We present a case of an otherwise healthy 11 year old with sudden onset dysphagia that based on MRI and CT findings was most consistent with an esophageal duplication cyst. However upon surgical exploration, a circular disk like foreign body was identified adjacent to the esophagus. Given the patient's age and no reports of purposeful ingestion, it is most likely the patient had ingested this disk foreign body in early childhood, leaving her asymptomatic for 8 years prior to presentation.
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Affiliation(s)
- Matthew Shew
- Department of Otolaryngology Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Zi Jiang
- Department of Otolaryngology Head and Neck Surgery, Children's Mercy, Kansas City, MO, USA
| | - Daniel Bruegger
- Department of Otolaryngology Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Jill Arganbright
- Department of Otolaryngology Head and Neck Surgery, Children's Mercy, Kansas City, MO, USA.
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Huang ZJ, Guffey D, Minard CG, Friedman EM. Outcomes variability in non-emergent esophageal foreign body removal: Is daytime removal better? Int J Pediatr Otorhinolaryngol 2015; 79:1630-3. [PMID: 26292907 DOI: 10.1016/j.ijporl.2015.06.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 06/18/2015] [Accepted: 06/20/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective of this study is to investigate differences between esophageal foreign body removal performed during standard operating room hours and those performed after-hours in asymptomatic patients. METHODS A retrospective chart review at a tertiary children's hospital identified 264 cases of patients with non-emergent esophageal foreign bodies between 2006 and 2011. Variables pertaining to procedure and recovery times, hospital charges, complications, length of stay, American Society of Anesthesiology (ASA) classification, and presence of mucosal injury were summarized and compared between cases performed during standard operating hours and those performed after-hours. RESULTS Cases performed during standard hours had significantly longer average wait times compared with after-hours cases (13.1h versus 9.0h, p<0.001). No other clinical characteristics or outcomes were significantly different between groups. Longer wait times are not associated with mucosal injury or postoperative complications. CONCLUSION There were no significant differences in procedure time, charges, or safety in after-hours removal of non-emergent esophageal foreign bodies compared to removal during standard operating hours. OR wait time was about 4h longer during standard hours compared with after-hours. This study could not assess the factors to determine the impact in differences in hospital resource utilization or work force, which may be significant between these two groups.
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Affiliation(s)
- Zhen J Huang
- Baylor College of Medicine, Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, United States.
| | - Danielle Guffey
- Baylor College of Medicine, Dan L. Duncan Institute for Clinical and Translational Research, United States.
| | - Charles G Minard
- Baylor College of Medicine, Dan L. Duncan Institute for Clinical and Translational Research, United States.
| | - Ellen M Friedman
- Baylor College of Medicine, Texas Children's Hospital Director of the Center for Professionalism in Medicine, United States.
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Abstract
AIM: To determine the risk factors associated with esophageal complications of ingestion of fish bones in adults.
METHODS: Seventy-five adult patients who had ingestion of fish bones were investigated at our hospital. The complications were analyzed and the risk factor for them were identified with regard to patient characteristics, fish bone characteristics and the relationship between fish bones and the esophageal wall. Binary Logistic regression was used to explore the associations between the potential risk factors (independent variables) and the complications (dependent variables).
RESULTS: Forty-six cases had complications associated with ingestion of fish bones, which included erosions (23, 30.26%), lacerations (10, 13.16%), ulcers (8, 10.53%), and perforation (5, 6.58%). Multivariate Logistic regression analysis showed that the esophageal wall being penetrated by fish bone, obvious symptoms, history of strong swallowing and duration of impaction ≥ 24 h were significant independent risk factors for complications (P < 0.05).
CONCLUSION: The risk for complications in patients with the esophageal wall being penetrated by fish bone or obvious symptoms is higher. In patients who have no history of strong swallowing or receive early diagnosis and treatment, the risk of complications is lower.
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Chang JM, Yoo YS, Kim DW. Application of Three-dimensional Reconstruction in Esophageal Foreign Bodies. Korean J Thorac Cardiovasc Surg 2011; 44:368-72. [PMID: 22263191 PMCID: PMC3249343 DOI: 10.5090/kjtcs.2011.44.5.368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2011] [Revised: 04/26/2011] [Accepted: 06/03/2011] [Indexed: 11/16/2022]
Abstract
This study was conducted to investigate the clinical application of three-dimensional (3D) reconstructed computed tomography (CT) images in detecting and gaining information on esophageal foreign bodies (FBs). Two patients with esophageal FBs were enrolled for analysis. In both cases, 3D reconstructed images were compared with the FB that was removed according to the object shape, size, location, and orientation in the esophagus. The results indicate the usefulness of conversion of CT data to 3D images to help in diagnosis and treatment. Use of 3D images prior to treatment allows for rapid prototyping and surgery simulation.
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Affiliation(s)
- Ji-Min Chang
- Department of Thoracic and Cardiovascular Surgery, Inje University Sanggye Paik Hospital, Korea
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37
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Khaleghnejad Tabari A, Mirshemirani A, Rouzrokh M, Seyyedi J, Khaleghnejad Tabari N, Razavi S, Talebian M. Tracheoesophageal fistula following disc battery ingestion and foreign body impaction. Caspian J Intern Med 2011; 2:336-339. [PMID: 24551442 PMCID: PMC3895833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 07/15/2011] [Accepted: 08/23/2011] [Indexed: 06/03/2023]
Abstract
BACKGROUND Ingestion of foreign bodies may result in the formation of a tracheoesophageal fistula (TEF), which causes severe morbidity in children. We describe four cases of TEF, who underwent emergent surgery for repair. CASE PRESENTATION In this report, we present about four patients aged between 9 months to 2.5 years, who referred due to disc battery ingestion. There were two boys and two girls. The common symptoms were cough, cyanosis, and dysphagia, choking and vomiting. The diagnosis was performed through an x-ray, barium swallow and CT Scan. All batteries were impacted in the esophagus, two in upper, one in the middle, and one in lower esophagus position. All disc batteries were removed endoscopically, but had tracheoesophageal fistula (TEF). All the patients underwent TEF repaired surgically. There was no morbidity in four patients, but one patient developed moderate esophageal stenosis, which was repaired by staged dilatation. There was no mortality in our cases. CONCLUSION Long-term impaction of foreign bodies may result in tracheoesophageal fistula. This complication may be seen earlier with alkaline disc batteries. Removal of these foreign bodies should be followed carefully for the diagnosis and treatment of these fistulas.
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Affiliation(s)
- Ahmad Khaleghnejad Tabari
- Pediatric Surgery Research Center, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Mirshemirani
- Pediatric Surgery Research Center, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Rouzrokh
- Pediatric Surgery Research Center, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Javad Seyyedi
- Pediatric Surgery Research Center, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasibeh Khaleghnejad Tabari
- Pediatric Surgery Research Center, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sajad Razavi
- Pediatric Surgery Research Center, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahshid Talebian
- Pediatric Surgery Research Center, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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38
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Mirza B, Saleem M, Sheikh A. Broken piece of silicone suction catheter in upper alimentary tract of a neonate. APSP J Case Rep 2010; 1:8. [PMID: 22953251 PMCID: PMC3417984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2010] [Accepted: 07/11/2010] [Indexed: 12/05/2022] Open
Abstract
Esophageal foreign bodies (FB) are common in adults and children. These are rarely reported in infants and neonates. A 2-day-old newborn was referred to our hospital with history of accidental intrusion of soft silicone suction catheter into the upper gastrointestinal tract (GIT). X-ray chest and abdomen confirmed the presence of suction tube in esophagus and stomach. The suction catheter was retrieved successfully at direct laryngoscopy.
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