Metallic Foreign Body Migrating into Prevertebral Muscles: How We Did It?

Abstract

Accidental ingestion of foreign bodies is common in ENT practice. A very small number of ingested foreign bodies perforate the esophagus and even a smaller fraction of extra mucosal migration penetrates into the soft tissues of the neck. Most cases reported in the literature involve fish bones. If left untreated, they may result in life threatening complications. This case presents a patient with a metallic foreign body (metal wire) in the esophagus which migrated extraluminally into the prevertebral muscle of the neck and describes the difficulties encountered in removing the migrated foreign body. Intra-operative radiography using two metallic pointers was used to locate the exact position of the foreign body during exploration of the neck.

What do Head and Neck Surgery and Orthopedics have in Common? An Unusual Case of Metallic Foreign Body

“…However, it should be kept in mind that the position of the neck during CT scan and surgery may not be the same because soft tissues of the neck are mobile in relation to the bony and cartilaginous structures so as the position of the foreign body. In our case because of the neck was extended during surgery, the foreign body was found deeper than what was seen on CT scan [11]. Exploration of the neck to locate the foreign body can sometimes be a frustrating experience for the surgeon as was completely true in this case.…”

Spectrum of imaging findings in trans-gastric migration of accidently ingested metallic foreign bodies

“…An ingested foreign body may get lodged in the vallecula, pyriform sinus, esophagus or may pass into stomach. 1 Commonly reported symptoms following foreign body ingestion include coughing, choking, dysphagia and odynophagia. Radiographs, ultrasonography, fluoroscopy and computed tomography (CT) are the key imaging modalities to rapidly diagnose the exact location and nature of ingested foreign body.…”

“…Tissue reaction to the foreign body as well as infection and abscess formation could also play a part. 1,4 A migrated foreign body may remain quiescent or may lead to pain, odynophagia or may result in complications which may include suppurative complications like retropharyngeal, parapharyngeal, perigastric or intraperitoneal collections and mediastinitis. Vascular complications like carotid rupture, penetration of facial artery, aorto-esophageal and innominateesophageal fistula have also been reported.…”

“…Vascular complications like carotid rupture, penetration of facial artery, aorto-esophageal and innominateesophageal fistula have also been reported. 1,2,5 Migration of a foreign body should be suspected when endoscopy fails to locate and/or retrieve the foreign body. An abdominal radiograph is the preliminary investigation to locate a foreign body.…”

“…Extraluminal migration of a foreign body may lead to pain, suppurative or vascular complications. [1][2][3] Radiographs, ultrasonography, fluoroscopy and computed tomography (CT) are the key imaging modalities to rapidly diagnose the exact location and nature of ingested foreign body. Key imaging features include size, shape, density, exact location and associated obstruction if any.…”