Foreign bodies in aero-digestive tract in children: spectrum of presentation and management

Background: Foreign body (FB) ingestion and aspiration is quite common in children. It can be a life-threatening condition. Early diagnosis of foreign body aspiration is essential as delay in its recognition and treatment results in high morbidity and mortality. Symptoms seem to mostly depend on the anatomical location. The absence of specific symptoms indicating the occurrence of FB injury can lead to delay in diagnosis, thereby increasing the risk of complications.Methods: This is a prospective study which comprised of 50 patients with between 8 months and 4.5 years. FB involving different parts of the aero-digestive tract were included in the study. The site, side, symptoms and radiographic findings were recorded for each patient. Different procedures were used for retrieval of various FB at different locations. Majority of these procedures were performed under anaesthesia.Results: Most of the FB were organic in nature. Right side bronchus was more commonly involved. A combination of different procedures was used according to the site involved. All the FB were removed successfully and smoothly. There was minimum morbidity with no mortality and the overall outcome was excellent. Hospital stay varied according to the site of involvement.Conclusions: The symptoms of FB change with the site involved and many patients are even asymptomatic. A differential diagnosis of foreign body should always be made in an acute or chronic presentation of respiratory cases. Aspiration of foreign body should be suspected in all cases of broncho-pulmonary infection with atypical course. High index of suspicion is the cornerstone of diagnosis. Bronchoscopy is the best diagnostic and therapeutic method in all suspicions of foreign body of tracheo-bronchial tree. Proper and timely intervention optimizes the outcome.

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Unexpected source of Proteus mirabilis bacteraemia

BMJ Case Reports ◽

10.1136/bcr-2018-226744 ◽

2018 ◽

Vol 11 (1) ◽

pp. bcr-2018-226744

Author(s):

Sureshkumar Nagiah ◽

Rassam Badbess

Keyword(s):

Proteus Mirabilis ◽

Elderly Woman ◽

High Morbidity ◽

Vascular Risk ◽

Infected Aneurysm ◽

Gram Negative ◽

Delay In Diagnosis ◽

Common Causes ◽

Threatening Condition ◽

Life Threatening

Mycotic (infected) aneurysm involving the thoracic aorta is an exceedingly rare and life-threatening condition that is associated with high morbidity and mortality. We report an unusual source of Proteus mirabilis bacteraemia thought to be due to an infected aneurysm in the thoracic aortic arch in an elderly woman. Source of gram-negative bacteraemia is usually isolated to an intra-abdominal or a pelvic source. Proteus bacteraemia from an intrathoracic pathology is very uncommon, and in this case led to a delay in diagnosis. Although an infected aneurysm is a rare source of gram-negative bacteraemia, it must always be considered when common causes of bacteraemia have been ruled out especially in patients with vascular risk factors.

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Capsular dissection technique for reducing recurrent laryngeal neuropraxia and temporary hypoparathyroidism after thyroidectomy: a single center experience

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20212445 ◽

2021 ◽

Vol 7 (7) ◽

pp. 1111

Author(s):

Dimple Sahni ◽

Rajwant Kaur ◽

Gagandeep Kaur ◽

Sangeeta Aggarwal ◽

Sanjeev Bhagat

Keyword(s):

Foreign Body ◽

Foreign Bodies ◽

Single Center ◽

Single Center Experience ◽

Clinical Presentations ◽

Life Threatening ◽

High Index Of Suspicion ◽

A Prospective Study ◽

Dissection Technique ◽

Nose And Throat

Background: Foreign bodies in aerodigestive tract is common, frequent, and sometime life threatening emergency for otorhinolaryngologists mainly in the paediatric group. The aims of the present study was to find the incidence of foreign bodies, in relation to demographic factors, type and sites of foreign bodies its clinical presentations and its management.Methods: A prospective study was conducted on 100 cases coming to the ear, nose and throat (ENT) emergency and outpatient department (OPD). After thorough history, clinical examination, routine blood and urine investigations and urine done. Radiological examination was done to visualize the radio-opaque foreign body, and if the foreign body was not radio-opaque then computed tomography (CT) scan was done. Results: Incidence of foreign was 67% in male than 33% in female. Mostly foreign bodies were in nose (49%), followed by oesophageal (31%), abdominal (14%), and bronchus (6%) respectively. 33% were totally asymptomatic, 25% with mucupurulent discharge from nose, dysphagia (16%), nasal obstruction (15%), and odynophagia (11%) respectively. Most of the foreign bodies were inorganic in nature, coin (42%), pearls (8.16%), and battery (6.45%). Among organic foreign bodies peanut was most common (33.33%), grains (10%). All foreign bodies were removed successfully with minimal morbidity and zero mortality.Conclusions: Present study suggested incidence was very common among male children, in rural background, with common asymptomatic presentation. With high index of suspicion, and proper and timely intervention all 100 cases were managed successfully. But still educating the parents about keeping such things away from kids prevent these incident.

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Dentures that keeps airway patent: a case report

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20200071 ◽

2020 ◽

Vol 6 (2) ◽

pp. 394

Author(s):

Siti F. A. Razak ◽

Stacy A. Jamarun ◽

Siti H. Sanudin

Keyword(s):

Case Report ◽

Foreign Body ◽

Motor Vehicle ◽

Motor Vehicle Accident ◽

Foreign Body Aspiration ◽

Main Complaint ◽

Vehicle Accident ◽

Threatening Condition ◽

Life Threatening ◽

High Index Of Suspicion

Foreign body aspiration is a life-threatening condition that requires immediate attention and intervention. Foreign body aspiration in adults usually occurs during dental procedure or motor vehicle trauma. Classical symptoms include choking, cough, haemoptysis, hoarseness or stridor. This case report presents an incident of a foreign body lodged at the subglottic region in an adult wearing dental prosthesis; the main complaint was hoarseness post motor vehicle accident. High index of suspicion coupled with correct investigation will facilitate the diagnosis of a foreign body in the airway thus immediate intervention can be taken to prevent morbidity and mortality.

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Panorama of foreign body in upper digestive tract in the population of Uttarakhand

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20190772 ◽

2019 ◽

Vol 5 (2) ◽

pp. 416

Author(s):

Chetan Bansal ◽

Prerana Bharti ◽

V. P. Singh

Keyword(s):

Foreign Body ◽

Digestive Tract ◽

Foreign Bodies ◽

Clinical Presentation ◽

Medical Emergency ◽

Age Group ◽

Common Site ◽

Sex Type ◽

Type Site ◽

A Prospective Study

Background: Foreign body aspiration is more common in children than adults because they explore the world with their hands and mouth and also have incomplete control and immature judgment. Foreign bodies in ENT are a medical emergency as their removal demands great skill due to unpredictability in the procedure and the complications associated with it.Methods: A prospective study was conducted on 40 cases of digestive tract foreign bodies in relation to age, sex, type, site, clinical presentation, extraction and complications. Results: Youngest child was 5 months old. Most predisposed age group was 0-5 years (60% of cases). Cricopharynx (24 cases) was the most common site of impaction for foreign body. In the present study toys (22.5%) were most common foreign bodies followed by coins (15%) ingestion.Conclusions: Avoid carelessness. Avoid hasty drinking, eating, talking and running with anything in the mouth. Keep the things out of reach of the children. Be particular in sleep, anesthesia, coma or delirium. Avoid putting objects into mouth.

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Acute Fatty Liver of Pregnancy: A Life Threatening Condition

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v15i1.29348 ◽

2020 ◽

Vol 15 (1) ◽

pp. 79-80

Author(s):

Sarita Sitaula ◽

Ajay Agrawal ◽

Achala Thakur ◽

Tara Manandhar ◽

Babauram Dixit Thapa ◽

...

Keyword(s):

Fatty Liver ◽

Postpartum Hemorrhage ◽

Post Partum ◽

High Morbidity ◽

Third Trimester ◽

Delay In Diagnosis ◽

Threatening Condition ◽

Life Threatening ◽

Acute Fatty Liver ◽

Catastrophic Disease

Acute Fatty Liver of Pregnancy (AFLP) is a rare but catastrophic disease affecting women in pregnancy. It usually occurs in the third trimester or post-partum period. Delay in diagnosis is associated with morbid complications with high morbidity and mortality. We report a case of 24 years old female at 38 weeks period of gestation who presented with jaundice, vomiting for 3 days and deranged liver function test. She was diagnosed as acute fatty liver of pregnancy and was delivered by instrumental delivery but required cesarean hysterectomy due to postpartum hemorrhage. She started improving with supportive care and discharged after 4 weeks of hospital stay. Key words: AFLP, Hysterectomy, Postpartum hemorrhage

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Multiple foreign body aspiration: a case report

Pediatria i Medycyna Rodzinna ◽

10.15557/pimr.2020.0060 ◽

2020 ◽

Vol 16 (3) ◽

pp. 325-328

Author(s):

Aranjit Singh Randhawa ◽

◽

Norhafiza Mat Lazim ◽

Khairul Bariah Noh ◽

Irfan Mohamad ◽

...

Keyword(s):

Case Report ◽

Foreign Body ◽

Tracheobronchial Tree ◽

Foreign Body Aspiration ◽

High Morbidity ◽

Age Group ◽

Delay In Diagnosis ◽

Cardiopulmonary Complications ◽

Paediatric Age ◽

Group A

Foreign body in the tracheobronchial tree is an emergency commonly affecting the paediatric age group. A delay in diagnosis and removal may cause high morbidity and mortality. We report a case of a 1-year-6-month-old presenting with multiple peanuts aspirated into both lungs, ultimately resulting in death due to cardiopulmonary complications. The aim of the case report is to highlight the importance of thorough history-taking from parents, intraoperative suspicion of more than a single aspirated foreign body, and meticulous measurements taken to minimise extraction time.

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Upper gastro intestinal foreign bodies in pediatrics patients

Journal of Health and Allied Sciences NU ◽

10.1055/s-0040-1703933 ◽

2015 ◽

Vol 05 (04) ◽

pp. 040-044

Author(s):

Venkatesh M. Annigeri ◽

Bahubali D. Gadgade ◽

Rashmi V. Annigeri ◽

Anil B. Halgeri

Keyword(s):

Foreign Body ◽

Digestive Tract ◽

Foreign Bodies ◽

Major Complication ◽

Esophageal Disease ◽

Age Group ◽

Magill Forceps ◽

Upper Digestive Tract ◽

Flexible Esophagoscopy ◽

A Prospective Study

Abstract Aim: Analyzeexperience with presentation, diagnosis and management of accidental ingested upper digestive tract foreign bodies in children. Materials: A prospective study of 60 pediatric patients from July 2009 to July 2014 with history of accidental ingested upper gastro intestinal foreign bodies. All patients were studied for age, gender, complaints, duration, site of impaction, type and complications. Radiological investigations were taken according to the case. Direct laryngoscopy and Magill forceps or flexible esophagoscopy has been used for retrieval of foreign bodies. Result: Sixty cases were analyzed age between 6 months to 13 years. Male 42 and female 18. Age group 6 months to 6 years constitutes 85%. Thirty six (60%) patients arrived to hospital within 24 hours. Difficultly in swallowing (70%) was the most frequent symptom. Most foreign bodies were coin in the upper esophagus (70%). Preexisting esophageal disease was present in 20%. Out of 60 patients twenty four (40%) FB retrieved using Magill forceps and rest with Flexible esophagoscopy (60%). Foreign bodies were successfully removed without major complication in all cases. Mucosal erosions were seen in four patients after extraction. All patients except 4 were discharged within 24 hours after the procedure. Conclusion: Children between 6 month to 6 years is the commonest age group affected. Magill forceps with the aid of a direct laryngoscope is a safe and effective method for proximal esophageal foreign body removal. But flexible esophagoscopy remains the safest method of upper digestive tract foreign body extraction.

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Analysis of enteric ileal perforation: a prospective study in a tertiary care hospital

International Surgery Journal ◽

10.18203/2349-2902.isj20170475 ◽

2017 ◽

Vol 4 (3) ◽

pp. 899

Author(s):

Prabu Shankar S. ◽

Sudarshan P.B. ◽

Sundaravadanan B.S.

Keyword(s):

Prospective Study ◽

Tertiary Care ◽

Wound Dehiscence ◽

Fecal Fistula ◽

High Morbidity ◽

Care Hospital ◽

Female Ratio ◽

Ileal Perforation ◽

Delay In Diagnosis ◽

A Prospective Study

Background: Intestinal perforation as a complication of enteric fever is still a serious problem in developing nations. Enteric ileal perforation is associated with high morbidity and mortality and many patients present in a severe toxic state because of delay in diagnosis and late presentation to hospital.Methods: A prospective study was conducted to assess the prognostic factors in enteric ileal perforation. Observations were made regarding symptoms, signs, duration of illness and presentation of patients to the hospital after acute episode. Per operative findings regarding site, size and number of perforations were recorded. Operative procedures were simple closure, ileostomy, or resection of diseased segment including right hemicolectomy done for associated caecal perforation and entero enteric anastomosis. Post-operative complications like wound infection, wound dehiscence, residual abscess, faecal fistula and deaths were documented.Results: There were 50 enteric ileal perforation cases with a age range of 13-80 with a mean age of 30.7. Male: female ratio was 11: 1. 85% of patients presented within 48 hrs of onset of symptoms of perforation and there is significant mortality in patients who presented more than 48 hrs of onset of symptoms of perforation (57.14%). Mortality was high in multiple perforation group (40%) and also higher incidences of fecal fistula and wound dehiscence.Conclusions: Age and sex have no bearing on the outcome. Perforation presentation interval, delay in surgery, number of perforations are important prognostic markers for typhoid ileal perforation.

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Migratory Foreign Body Presenting with Thyroid Abscess

Bengal Journal of Otolaryngology and Head Neck Surgery ◽

10.47210/bjohns.2021.v29i2.440 ◽

2021 ◽

Vol 29 (2) ◽

pp. 200-203

Author(s):

Sudip Kumar Das ◽

Chiranjib Das ◽

Pritam Chatterjee ◽

Shubhrakanti Sen ◽

V D Prasanna Kumar Vasamsetty

Keyword(s):

Foreign Body ◽

Digestive Tract ◽

Soft Tissues ◽

Fatal Case ◽

Plain Radiography ◽

Accidental Ingestion ◽

Upper Digestive Tract ◽

Thyroid Abscess ◽

And Migration ◽

High Index Of Suspicion

Introduction The most common complication following accidental ingestion of a foreign body is entrapment in the upper digestive tract. Spontaneous penetration of a foreign body through the upper digestive tract and migration into the soft tissues of the neck is very uncommon. Consequences from such migratory foreign body can be serious and potentially fatal. Case Report Thirty six years old female presented with history of accidental ingestion of an unknown foreign body 3 days back. Clinical examination, plain radiography, hypopharyngoscopy and oesophagoscopy failed to find out the foreign body. Thereafter the patient developed thyroid abscess which was confirmed by computed tomography. Surprisingly we discovered the foreign body during surgical exploration of neck. Conclusion In a case of accidental ingestion of foreign body, even if initial evaluation with endoscopy and plain radiography are negative, the patient should be followed closely until resolution of symptoms. A high index of suspicion of migration of foreign body should be maintained. Retrieval of migratory foreign body needs surgical expertise and experience.

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Challenges in treating patients with foreign bodies in hypopharynx and esophagus: our experience in a tertiary care hospital

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20213902 ◽

2021 ◽

Vol 7 (10) ◽

pp. 1660

Author(s):

Nambiar Sapna S. ◽

Swathilal S. A. ◽

Sunilkumar K. P. ◽

Soumya Aravind M. V.

Keyword(s):

Foreign Body ◽

Esophageal Perforation ◽

Foreign Bodies ◽

Tertiary Care ◽

Care Hospital ◽

Foreign Body Removal ◽

Rigid Endoscopy ◽

Sudden Decrease ◽

High Index Of Suspicion ◽

A Prospective Study

Background: Foreign bodies (FBs) of the hypopharynx and esophagus are among the common otolaryngologic emergencies. Every new case poses a clinical challenge with need for optimal treatment strategy. The objective of our study is to highlight a few of the challenges faced while treating these patients.Methods: A prospective study was done on all patients who reported to the ENT casualty, Government Medical College Kozhikode with history or suspicion of foreign body throat from January 2020 to January 2021. A total of 160 patients reported of which 48 (30%) patients required further evaluation with rigid endoscopy and foreign body removal in the operative room. A few challenges like migration of foreign bodies, dilemma in diagnosis with FB mimicking ossified cartilages on X-ray, FB removal in mentally challenged patients and treatment of esophageal perforation post rigid endoscopy are discussed.Results: Only 48 (30%) patients of the total 160 patients required rigid endoscopy and foreign body removal in the operating room. The foreign body was obtained in 42 (87.5%) patients while 6 (12.5%) patients improved post rigid endoscopy though foreign body was not obtained. One patient with denture in the esophagus developed esophageal perforation requiring prolonged hospital stay.Conclusions: A high index of suspicion among patients presenting with dysphagia, neck pain and sudden decrease in food intake is warranted. Early diagnosis with appropriate imaging modalities is essential for confirmation of diagnosis. Dentures are among FBs that necessitate more caution. Esophageal perforation, a rare but life-threatening complication must be diagnosed timely with appropriate surgical intervention.

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