Ingested sharp foreign body presented as chronic esophageal stricture and inflammatory mediastinal mass for 113 weeks: Case report

Abstract

Introduction Impacted foreign bodies in the esophagus have the potential to cause serious complications. Ingested sharp objects carry the risk of acute complications as: perforation, acute mediastinitis, and acute bleeding. Rarely, such foreign bodies might migrate through the esophageal wall and present as chronic esophageal foreign body. Case presentation We present a case of a 36-month-old girl presented with solid food dysphagia and regurgitation proved to be secondary to esophageal stricture after 26 months of accidental ingestion of aluminum can tab which has migrated through the wall of the upper esophagus into the mediastinum. After two trials of endoscopic treatment; she underwent thoracotomy and partial esophagectomy. Multiple trials of dilation and Mitomycin C injection were followed because of re-stricture. Conclusion Foreign body impaction or secondary stricture needs to be considered in the differential diagnosis of children presenting with new onset dysphagia and regurgitation. Metallic Foreign body might be even radiolucent. Practitioners should keep a high index of suspicion for a retained esophageal FB in the child with gastrointestinal or respiratory symptoms that do not respond to standard therapy.

Open Thoracic Surgery for Removal of a Two-Year-Old Impacted Esophageal Coin

“…Multiple [11]. Tashtush and colleagues reported of a 36-month old baby who had a 26 months history of chronic oesophageal foreign body before diagnosis [12], this is similar to our case who had the impacted coin stayed for two years. Foreign body impaction most commonly occurs at the cricopharyngeal junction due to it being the narrowest part of the oesophagus.…”

“…In the event that endoscopic retrieval is impossible, the best option is surgical approach especially in the presence of life-threatening complications or anticipation of their occurrence if approached endoscopically [12] [13]. A review of 9 published papers by Cianci et al showed that endoscopic failure to retrieve the foreign body was a paramount indication for surgical intervention [9] similar to our case.…”

“…Radio-opaque objects are easily diagnosed on radiological biplanar films, be it x-ray or CT scan while radiolucent objects such as meat or food bolus may be easily missed unless it contains cartilage or some bones [9]. CT scans are useful to determine possible involvement of surrounding structures or to further evaluate if endoscopy yields negative results as was seen in the case report by Tashtush and associates [4] [12].…”

“…However, options for management of impacted foreign bodies are endoscopic removal and surgical retrieval [13] if spontaneous passage does not occur. The first-line option for foreign body retrieval is rigid or flexible esophagoscopy done under general anaesthesia [12]. Lin et al reported a success rate of 88.8% in the utilization of endoscopy for oesophageal foreign body retrieval with an associated complication rate of 13.3%.…”

Laparo-endoscopic combination for the safe extraction of an open safety pin in a 9-month-old child. Case report

“…The transit through the gastrointestinal tract is completed spontaneously in an average of 3.6 days [ 4 ]. Nevertheless, FB can impact at some point, causing dangerous consequences: about 20% of cases impact within the oesophagus where the FB can cause the formation of bronchoesophageal fistula, aortoesophageal fistula, oesophageal perforation with subsequent mediastinitis or abscess, complete oesophageal stricture or oesophageal obstruction, pulmonary oedema, oesophageal diverticulum [ 10 , 11 ]. The probability of impaction depends on the quality, shape, size of the foreign body, and the child's medical status.…”