Abstract
Foreign body impactions in the aerodigestive tract are common, but have the potential for serious complications. A foreign body may disrupt the mucosal lining and migrate regionally thereby risking impingement or injury to critical neurovascular structures in the cervical region. It is important to recognize potential complications that may arise from luminal compromise. In such cases, expeditious surgical treatment is warranted.
1
Introduction
Aerodigestive tract foreign body ingestion in the pediatric population is commonly seen in otolaryngology. Given the close proximity of important anatomic structures, there is potential for serious morbidity or even mortality. Complications stemming from luminal perforation include infection, vascular, or neurologic injury. We present a case of hypopharyngeal foreign body impaction extending to the vertebral canal that highlights the hazardous nature of these cases and the necessity for urgent surgical intervention.
2
Case report
An otherwise healthy 13-year-old male presented to the emergency department with a one-day history of cervical pain, dysphagia, and blood tinged sputum. The patient admitted to having swallowed a large sewing needle while playing approximately five days prior to presentation. Plain cervical radiographs revealed a linear metallic foreign body in the proximal pharynx. A cervical stabilizing collar was placed and the patient was subsequently transferred to our tertiary institution for further management.
The patient was stable upon arrival without respiratory symptoms or neurologic sequelae. Empiric intravenous broad-spectrum antibiotics were commenced and a contrasted computed tomography angiogram (CTA) demonstrated a radiopaque foreign body lodged in the proximity of the right piriform sinus and positioned over the C4 vertebrae [ Fig. 1 ]. The object extended beyond the retropharyngeal space into the transverse foramina immediately adjacent to the left vertebral artery [ Figs. 2 A, B ]. No evidence of vascular injury was found. The decision was made to urgently proceed with surgical exploration.
Following general mask anesthesia, direct laryngoscopy revealed the round head of a pin obliquely entering the right posterior pharyngeal wall. An endotracheal tube was placed and secured under direct visualization. Suspension laryngoscopy was performed and the shaft of the pin was engaged and meticulously extracted using cup forceps [ Fig. 3 ]. Following removal, examination revealed the punctate entry point, but no evidence of significant mucosal disruption, infection, or hematoma. Normal carotid artery pulsations were also appreciated.
The patient was monitored in the intensive care unit and post-operative cervical magnetic resonance angiography (MRA) was performed with no evidence of subintimal abnormalities or stenosis of the vertebral arteries. His symptoms rapidly improved over the following 24 hours and his diet was slowly advanced. Flexible fiberoptic laryngoscopy showed no evidence of bleeding, edema, or significant mucosal trauma of the hypopharynx. He was subsequently discharged with continued oral antibiotics and maintained an uneventful follow-up and recovery.
2
Case report
An otherwise healthy 13-year-old male presented to the emergency department with a one-day history of cervical pain, dysphagia, and blood tinged sputum. The patient admitted to having swallowed a large sewing needle while playing approximately five days prior to presentation. Plain cervical radiographs revealed a linear metallic foreign body in the proximal pharynx. A cervical stabilizing collar was placed and the patient was subsequently transferred to our tertiary institution for further management.
The patient was stable upon arrival without respiratory symptoms or neurologic sequelae. Empiric intravenous broad-spectrum antibiotics were commenced and a contrasted computed tomography angiogram (CTA) demonstrated a radiopaque foreign body lodged in the proximity of the right piriform sinus and positioned over the C4 vertebrae [ Fig. 1 ]. The object extended beyond the retropharyngeal space into the transverse foramina immediately adjacent to the left vertebral artery [ Figs. 2 A, B ]. No evidence of vascular injury was found. The decision was made to urgently proceed with surgical exploration.
