Inadvertent ingestion of foreign bodies, particularly fish bone, are a common complaint in the otolaryngology emergency practices in Southeast Asia. Due to its thin, linear, and sharp pointed end, fish bone has the potential to penetrate through the oesophagus wall, or migrate extraluminally towards the surrounding structures in the neck, resulting in bizarre and lethal complications. We present an unusual case of extraluminal migration of foreign body (FB) and 2 cases of completely embedded FB in the oesophagus wall. We aim to share our experience in both conservative approach and transcervical approach for these difficult clinical problems. All of them have minimal rigid oesophagoscopy findings but possess the radiological evidence of FB. Computed tomography scan have higher sensitivity and provide good preoperative guidance, it should be done early and performed in the event of negative endoscopic evaluation. Prompt diagnosis and early retrieval of FB can significantly reduce morbidity and mortality.
A paediatric bronchoscopy procedure for foreign body inhalation is indeed a highly challenging procedure due to multiple risk factors such as lower physiological functional residual capacity and adverse pulmonary function effects by anaesthetic agents in addition to concurrent active lungs infection. Here we elucidate a novel technique of foreign body removal located at the distal airway in a paediatric patient and in a situation where a paediatric flexible bronchoscopy with built-in working channel is not available. A 1-year 7-months-old boy presented with acute respiratory distress syndrome following a one-week history of active respiratory infection. On examination, he was tachypnoeic with audible soft inspiratory stridor and intermittent barking cough despite being supplemented with 3 liters /minute oxygen mask. Chest x-ray showed right upper lobe collapse. He was referred to the otorhinolaryngology team after a suspicious history of foreign body aspiration obtained from his mother. Bedside flexible nasopharyngolaryngoscopy showed granulation tissue at the junction of laryngeal surface of epiglottis and anterior commissure. He underwent emergency direct laryngoscopy, tracheoscopy, bronchoscopy, excision of granulation tissue and removal of foreign body under general anaesthesia. Herein, some of complicated bronchoscopy demand critical thinking of alternative or modified techniques to achieve a successful and safe surgery. Bangladesh J Otorhinolaryngol 2021; 27(2): 177-183
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