Delayed diagnosis of esophageal foreign body: A case report. (2017)

• Record Type: Journal Article
• Authors: Yahyaoui, Salem; Jahaouat, Imen; Brini, Ines; Sammoud, Azza
• Is Part Of: International journal of surgery case reports. Volume 36(2017)
• Page Start: 179
• Page End: 181
• Publication Date: 2017
• Subjects: FB foreign body -- EFB esophageal foreign body; Esophagus -- Foreign body -- Endoscopy -- Case report; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2017.05.028
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Stridor due to impacted esophageal foreign body in infants is a well known entity. but often forgotten. Persistent stridor and upper −airway obstruction with no obvious cause should arouse the suspicion of the esophageal foreign body in infants. Impacted oesophageal foreign bodies are usually treated endoscopically. When this approach is either unfeasible or unsuccessful, as in the case presented here, open surgical removal may be mandatory. In children, prevention of foreign body ingestion is better than cure. Abstract: Introduction: Foreign body (FB) ingestion, a common and serious problem in children, can present with a wide variety of symptoms. This paper describes and discusses the case of an esophageal foreign body (EFB), in which the patient presented with primarily respiratory clinical signs causing delayed diagnosis. Presentation of case: A six month old boy presented with three months history of harsh cough, stridor and pulmonary congestion. He was repeatedly treated with steroids and antibiotics. His symptoms worsened progressively. On examination, he was tachypneic with suprasternal recession, scattered crepitations, diffuse wheeze and a continuous stridor. Chest X-ray was normal. The flexible bronchoscopy showed a posterior external compression on the middle wall of the trachea. The CT scan was normal. The contrast X-ray study of the esophagus revealed an endoluminal filling defect. The esophagoscopy revealed narrowing at 12 cm of dental arch, and a bourgeoning yellow mass easily bleeding on contact. Esophageal biopsies were obtained, and histology was inconclusive. A surgical exploration was planned, but the infant forced out a pistachio shell after a chest physiotherapy session. Discussion: Ingestion of FB by small children is a common problem. The majority of EFBs pass harmlessly through the gastrointestinal tract; however, some EFBs can cause significant morbidities. The diagnosis may be delayed leading to several complications especially if the ingestion of the FB is unwitnessed and when the clinician does not think of FB ingestion as part of the differential diagnosis of chronic respiratory signs. Conclusion: This case highlights, the importance of recognizing, the rare and often forgotten respiratory symptoms of EFB body to avoid diagnostic delay especially in unwitnessed FB ingestion.