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

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