Traumatic Vocal Fold Paralysis from Fishbone Foreign Body: Diagnosis and Management.

Fish bone foreign bodies (FFBs) are relatively common but can present diagnostic challenges. Herein, we report a case of a 43-year-old female who initially presented to the Emergency Department with fever and throat discomfort after a choking incident, which led to a misdiagnosis of a viral infection after negative chest X-ray findings. Persistent symptoms, including new-onset vocal cord paralysis, prompted further investigation and an otolaryngology - head and neck surgery referral one month later. During the otolaryngology visit eight months after the initial incident, laryngoscopy revealed left true vocal cord paralysis and a subsequent CT scan revealed a 2.3 cm fishbone in the esophagus. Surgical removal involved flexible esophagoscopy and open neck exploration with careful dissection to avoid vascular injury. This case highlights the limitations of initial diagnostic methods, such as X-rays, and the necessity for heightened clinical vigilance and advanced imaging modalities like CT scans for persistent or evolving symptoms, particularly vocal cord paralysis. This case also supports multidisciplinary surgical management in cases of suspected esophageal FFBs involving the internal jugular vein and common carotid artery to prevent serious complications. Laryngoscope, 2024.

Diagnosis, treatment, and management of esophageal foreign bodies in patients with mental retardation: A retrospective study from three centers.

Background: This study aims to assess the outcomes and prognosis of surgical interventions aimed at removing esophageal foreign bodies in patients with mental retardation. Methods: Between January 2010 and January 2021, a total of 30 consecutive patients (20 males, 10 females; median age: 29.5 years; range, 2 to 57 years) with mental retardation who were diagnosed with esophageal foreign bodies and underwent surgical treatment were retrospectively analyzed. Age and sex of the patients, symptoms, type of the foreign body, esophageal stricture level, methods used for preoperative diagnosis, type of surgical procedure, postoperative complications, and length of hospital stay were recorded. Results: Seventeen (56.6%) patients had a foreign body in the first narrowing, 12 (40%) in the second narrowing, and one (3.3%) in the third narrowing. A rigid esophagoscopy was performed in all cases. However, successful removal was not achieved in two (6.6%) cases, and foreign bodies were removed through cervical esophagotomy in one (3.3%) patient and through esophagotomy with right thoracotomy in one (3.3%) patient. Postoperative complications included esophagitis in seven patients (23.3%) and wound infection and pneumonia in two patients (6.6%). The median length of hospital stay after treatment was 1.09 days in patients without complications and 3.3 days in patients with complications. There was a significant correlation between the occurrence of complications and the length of hospital stay (p=0.002). The foreign body was successfully removed in all patients, and no mortality was observed. Conclusion: Early diagnosis and emergency intervention can reduce complications, particularly considering the possibility of non-food and sharp-edged foreign bodies that pose a higher risk of damaging the digestive system, in patients with mental retardation than those without such conditions.

Decreasing the Size of Bottle Caps: Helping or Hurting Children?

OBJECTIVE: Our study aims to assess if decreasing bottle cap size was associated with more ingestions and injuries nationally. STUDY DESIGN: Retrospective chart review. SETTING: The National Electronic Injury Surveillance System (NEISS) database. METHODS: The NEISS was queried for bottle cap ingestions in children 0 to 18 years old between 2002 and 2021. Demographic factors including age, race, and sex of the patient were recorded. The location where the ingestion took place and the disposition of the patient were also analyzed. Data were excluded if the narrative did not specify the ingestion of a cap of a drinking bottle. RESULTS: A total of 415 bottle cap ingestion injuries were identified, for a national estimate of 11,683 injuries. The mean age at the time of ingestion was 10.3 ± 5.2 years and the majority of the injuries occurred in males (N = 9129, 78.4%). 46.4% (N = 5398) were Caucasian, 17.6% (N = 2046) were Black or African American, and 2.7% (N = 311) were Hispanic. 55.0% (N = 6405) of injuries occurred at an unknown location, 41.4% (N = 4781) occurred at home, and 2.8% (N = 326) occurred at school. 82.3% (N = 9584) of patients were treated in the emergency department and released, 6.9% (N = 808) were treated and admitted, 6.7% (N = 783) were treated and transferred, and 0.9% (N = 110) were held for observation. From 2002 (N = 6) to 2021 (N = 2291), there was a statistically significant increase in bottle cap ingestions (P < .001). CONCLUSION: Plastic bottle cap ingestions have increased in children over the last 20 years, coincident with the change to smaller bottle caps.

Laparoscopy-Assisted Transgastrointestinal Endoscopic Retrieval of a Denture Impacted in the Esophagus: A Case Report.

We report the management of a complex case involving a 66-year-old male with significant medical comorbidities who inadvertently swallowed a denture, leading to unsuccessful endoscopic removal attempts. CT scans revealed an esophageal perforation. Following an initial unsuccessful conventional endoscopic attempt, we employed a laparoscopy-assisted transgastrointestinal endoscopic approach. This novel technique facilitated the successful retrieval of the denture without further esophageal damage, underscoring its utility in managing challenging esophageal foreign bodies. The patient's postoperative recovery was uneventful, highlighting the safety and effectiveness of the procedure.

Foreign body aspirations with rigid bronchoscopy and esophagoscopy in children.

Foreign body aspirations and esophageal foreign bodies are lifethreatening conditions. Sometimes they or their complications can cause severe morbidity and even mortality. Their exact incidence is unknown. Foreign body aspirations and esophageal foreign bodies are most commonly observed in the pediatric age group. While interventions are generally required for the removal of respiratory tract foreign bodies, the majority of esophageal foreign bodies come out spontaneously. Removal of foreign bodies that block the lumen of the organ to a great extent, react with the mucosa such as battery magnets, and can cause poisoning, sharp-edged objects, and swellable foreign bodies such as legumes, should be done acutely. In the removal of foreign bodies, endoscopic methods (flexible/rigid bronchoscope) are used in the respiratory system. Other methods used in esophageal foreign bodies are follow-up and pushing and pulling maneuvers with equipment, and at times, open surgical procedures can be applied. The success of the procedures is high, and patients can be discharged in the early postoperative period. Their incidence can be decreased by raising awareness on the subject, parents can be prevented from making wrong applications in these cases, and clinicians can keep these conditions in mind in differential diagnosis. In this article, the clinical features and diagnosis and treatment methods of foreign body aspiration and esophageal foreign bodies will be discussed separately.

Resource Utilization and Risk Factors for Esophageal Injury in Pediatric Esophageal Foreign Bodies.

OBJECTIVE: While management protocols of pediatric esophageal foreign bodies (EFBs) are well-delineated, resource utilization can be improved. This study's objectives were to explore hospital charges/costs for pediatric patients who present with EFBs and to identify patient risk factors associated with esophageal injury. METHODS: A retrospective chart review of patients undergoing aerodigestive foreign body removal at a tertiary-care children's hospital from 2018 to 2021 was conducted. Data collected included demographics, medical history, presenting symptoms, EFB type, surgical findings, and hospital visit charges/costs. RESULTS: 203 patients were included. 178 of 203 (87.7%) patients were admitted prior to operation. Unwitnessed EFB ingestion (p < 0.001, OR = 15.1, 95% CI = 5.88-38.6), experiencing symptoms for longer than a week (p < 0.001, OR = 11.4, 95% CI = 3.66-38.6) and the following presenting symptoms increased the odds of esophageal injury: dysphagia (p = 0.04, OR = 2.45, 95% CI = 1.02-5.85), respiratory distress (p = 0.005, OR = 15.5, 95% CI = 2.09-181), coughing (p < 0.001, OR = 10.1, 95% CI = 3.73-28.2), decreased oral intake (p = 0.001, OR = 6.60, 95% CI = 2.49-17.7), fever (p = 0.001, OR = 5.52, 95% CI = 1.46-19.6), and congestion (p = 0.001, OR = 8.15, 95% CI = 2.42-27.3). None of the 51 asymptomatic patients had esophageal injury. The median total charges during the encounter was $20,808 (interquartile range: $18,636-$24,252), with operating room (OR) (median: $5,396; 28.2%) and inpatient admission (median: $5,520; 26.0%) contributing the greatest percentage. CONCLUSIONS: Asymptomatic patients with EFBs did not experience esophageal injury. The OR and inpatient observation accounted for the greatest percentage of the hospital charges. These results support developing a potential algorithm to triage asymptomatic patients to be managed on a same-day outpatient basis to improve the value of care. LEVEL OF EVIDENCE: Level 3 Laryngoscope, 2024.

Pediatric Esophageal Foreign Bodies and Caustic Ingestions.

Foreign body ingestions commonly occur in children aged under 6 years. While serious complications of ingestions are rare, sharp objects, caustics, multiple magnets, and button batteries can be associated with poorer outcomes including gastrointestinal (GI) obstruction, perforation, necrosis, and fistula formation. Initial workup should include history, physical examination, and plain film radiographs that will identify radiopaque objects. Removal of the foreign body is typically warranted if the object is high risk, it is located higher up in the GI tract, the patient is symptomatic, or the object is retained for a prolonged amount of time.

Pulmonary artery penetration due to fish bone ingestion: A rare case report.

Accidental fish bone ingestion is a common manifestation at emergency departments. In most cases, ingested foreign bodies usually pass uneventfully through the gastrointestinal tract and complications only present in less than 5% of all patients. In this report, we present the first documented case of pulmonary artery injury due to a fish bone in a 63-year-old male patient hospitalized with hemoptysis after accidentally swallowing a fish bone 30 days ago. This patient subsequently had surgery and endoscopy to safely remove the foreign body and then recovered well on a follow-up examination. For cases of fish bone ingestion, contrast-enhanced chest computed tomography is one of the most essential tools to assess vascular problems and associated mediastinal infections-risk factors for life-threatening and long-term recurrent inflammation. Reconstructing planes along the foreign body axis and changing windows when analyzing CT scans is necessary to avoid missing lesions and dilemmas.

Adult Esophageal Foreign Bodies.

This manuscript reviews and outlines the necessary tools to efficiently assess and manage an adult patient where an esophageal foreign body is suspected. It reviews the vulnerable populations and relevant diagnostics and provides a triage diagram to aid in timely intervention. Management with esophagoscopy is reviewed as well as potential complications that may arise. Lastly, to illustrate the concepts of this section, a case study is presented to highlight the salient points.

Factors Influencing the Fasting Time in Adult Patients After the Endoscopic Management of Sharp Esophageal Foreign Bodies.

Background: Sharp esophageal foreign body (SEFB) impaction can cause varying degrees of damage to the esophagus. There are few studies analyzing the postoperative fasting time in SEFB patients. Methods: We retrospectively collected 835 SEFB patients. According to the fasting time after the endoscopic removal (ER) of SEFBs, the patients were divided into two groups: short fasting time (SFT, fasted ≤24 h) and long fasting time (LFT, fasted >24 h). Results: There were 216 and 619 patients in the SFT and LFT group, respectively. The average age of the SFT group (52.97 years) was younger than that of the LFT group (55.96 years) (p = 0.025). The LFT group had lower proportion of duration of impaction (DOI) within 12 hours (14.2% vs 22.2%, p = 0.006) and erosion rates (89.0% vs 94.0%, p = 0.034) as well as higher proportion of esophageal perforation (19.5 vs 6.5%, p = 0.010) and patients who got intravenous anesthesia (63.78% vs 31.9%, p = 0.000) than the SFT group. The longest diameter of the foreign body (Lmax) in the LFT group (2.60 ± 1.01 cm) was greater than that in the SFT group (2.41 ± 0.83 cm; p = 0.01). Multivariate regression analysis found that age (OR = 1.726[1.208-2.465], p = 0.003), DOI (OR = 1.793[1.175-2.737], p = 0.007), Lmax (OR = 1.477[1.033-2.111], p = 0.032), perforation (OR = 3.698[2.038-6.710]; p < 0.01) and intravenous anesthesia (OR = 3.734[2.642-5.278]; p < 0.01) were the independent factors that prolonged fasting time in patients with SEFBs, while esophageal mucosal erosion (OR = 0.433[0.229-0.820]; p = 0.01) was the influencing factor leading to shortened fasting time. Conclusion: For the first time, we analyzed factors influencing the fasting time after ER in SEFB patients. Age, DOI, Lmax, perforation and intravenous anesthesia were risk factors for a prolonged postoperative fasting time.

Hematemesis on an esophageal foreign body revealing a double aortic arch: a case study.

A double aortic arch is a rare abnormality of the aortic arch caused by the persistence of the distal part of the right dorsal aorta. It can be manifested by respiratory and/or digestive symptoms. We report a case of double aortic arch revealed by an esophageal foreign body complicated by haematemesis in a 13-year-old boy having required multidisciplinary care.

Rigid Esophagoscopy for Foreign Body Extraction: Results and Complications in the Endoscopic Era.

Introduction Rigid esophagoscopy (RE) has long been a part of otolaryngology practice. In the past decades, the procedure was less commonly performed due to the advances and availability of flexible endoscopic techniques. This study aims to describe the outcomes of RE performed to treat foreign body ingestion and to evaluate risk factors associated with postoperative complications. Methods Patients who underwent RE to treat foreign body ingestion in an otolaryngology emergency department of a Portuguese tertiary university hospital, between 2010 and 2020, were included. A total of 162 cases were analyzed, and data was collected retrospectively. Results The most common foreign bodies were meat bone (31.5%, n = 47), food impaction (28.8%, n = 43), and fish bone (19.5%, n = 29). The proximal esophagus was by far the most frequent location (80%, n = 118). Esophageal perforation occurred in 8% (13 patients), and there was a 2.5% (n = 4) mortality rate. The odds ratio of an esophageal perforation if the foreign body was completely or partially located outside the proximal esophagus was 4.67 times that of a foreign body exclusively in the proximal esophagus (OR = 4.67 [95% CI: 1.39-15.72]; p = 0.016; Fisher's exact test). Conclusion RE remains an effective and important technique in the management of ingested foreign bodies, particularly if endoscopic removal is unsuccessful. Foreign body location outside the proximal esophagus was associated with esophageal perforation.

Foley catheter technique for the extraction of coins lodged in the upper esophagus of children.

INTRODUCTION: Coins are the most commonly ingested foreign bodies in children. They usually become lodged in the upper oesophagus and should be managed immediately. The aim of the present study was to evaluate the characteristics and outcomes of patients with coins lodged in the upper oesophagus, who underwent coin removal using a silicone Foley balloon catheter without fluoroscopy or anaesthesia and evaluate the safety of the procedure. MATERIALS AND METHODS: Patients who were admitted from January 2007 to December 2022 for coins lodged in the oesophagus and extracted with silicone Foley balloon catheter without anestehesia were evaluated retrospectively. We focused on the patient characteristics and clinical presentations, and the treatment safety, efficacy, and outcomes. RESULTS: 773 patients (416 male, 357 female), with a mean age of 3.5 years (range 6 months to 16 years), who ingested coin and extracted with Foley catether is included. The majority of patients (n = 728, 94.17%) were successfully managed by silicone Foley balloon catheter extraction. Our overall success was 94.17%, with 88.30% of coins retrieved and 5.9% pushed into the stomach. Patients who were successfully treated with Foley catheter were discharged on the same day except for 7 (0.90%) who had minimal bleeding. Only 45 (5.82%) patients required oesophagoscopy in the operating room and these patients were kept overnight for clinical follow-up, without any further interventions. CONCLUSION: A Foley balloon catheter can be used to safely and effectively remove coins that are lodged in the upper oesophagus avoiding the risk of general anesthesia.

Combination of gastroscopy and fibro­bronchoscopy facilitates removal of incarcerated fish bone in the esophagus: A case report.

Esophageal foreign body impaction is a notable clinical emergency. If the high-risk esophageal foreign bodies are not removed in time, life-threatening complications, such as perforation, infection and injury to the vessels, may occur. In the present study, the case of a patient experiencing a foreign body sensation in the throat after ingesting a fish bone by mistake is presented. A high risk of impending arterial puncture was confirmed using thoracic CT and thoracic aorta CT angiography scanning. The ends of the fish bone were first confirmed using a fibro-bronchoscopy light source passing through the bronchial and esophageal walls, before biopsy forceps were used to successively free the thoracic aorta and bronchial ends under gastroscopy. Finally, the fish bone was safely removed using a combination of gastroscopy and the rarely used fibro-bronchoscopy, and the patient recovered well after standard care. In certain cases of foreign bodies, it is necessary to use multiple strategies in a timely manner according to the type and location of the ingested foreign body.

Navigating the Esophagus: Effective Strategies for Foreign Body Removal.

Foreign body ingestion is a common medical emergency that can affect individuals of all ages and can be caused by various factors, including accidental ingestion, psychiatric disorders, intellectual disabilities, and substance abuse. The most common site for foreign body lodgment is the upper esophagus, followed by the middle esophagus, stomach, pharynx, lower esophagus, and duodenum. This article provides a case report of a 43-year-old male patient with a history of schizoaffective disorder and an indwelling suprapubic catheter who presented to the hospital due to foreign body ingestion. After examination, a metal clip from his Foley catheter was found lodged in his esophagus. The patient was intubated for the procedure, and an emergent endoscopic removal was performed to remove the metallic Foley component. No postoperative complications were observed, and the patient was successfully discharged. This case highlights the importance of considering foreign body ingestion in patients with chest pain, dysphagia, and vomiting. Prompt diagnosis and treatment are crucial to prevent potential complications such as perforation or gastrointestinal tract obstruction. The article also emphasizes the need for healthcare providers to know the different risk factors, variations, and common sites for foreign body lodgment to optimize patient care. Furthermore, the article highlights the importance of multidisciplinary care involving psychiatry and surgery to provide comprehensive care to patients with psychiatric disorders who may be at higher risk for foreign body ingestion. In conclusion, foreign body ingestion is a typical medical emergency that requires prompt diagnosis and treatment to prevent complications. This case report highlights the successful management of a patient with foreign body ingestion and emphasizes the importance of multidisciplinary care to optimize patient outcomes.

Neck Radiograph Halo Sign: Do Not Be Fooled.

An aerodigestive foreign body injury in the throat is an otorhinolaryngology (ORL) emergency. Button batteries and coins are the most common foreign body aspirations or ingestions among the paediatric population. An impacted button battery in the aerodigestive tract is a surgical emergency, requiring urgent removal to prevent complications arising from the corrosive nature of the button battery. We report two cases that were brought in with a history of foreign body ingestion. Both neck radiographs showed a double-ring opaque shadow. The first child had a button battery eroding into his oesophagus. The second case is an ideally impacted stack of coins of different sizes that mimic a double-ring shadow, better known as a halo sign, in an antero-posterior neck radiograph. These cases are unique in comparing ingested coins in alignment with a button battery and a radiological examination mimicking that of a button battery. In this report, we emphasize the importance of a thorough history, endoscopic examination, and the limitations of radiographs in the initial assessment of an ingested foreign body in terms of management and prediction of morbidity.

Successful Management of Aorto-Oesophageal Fistula Following Accidental Ingestion of Chicken Bone.

Accidental ingestion of foreign bodies is common in clinical practice. It is usually seen to pass through the gastrointestinal tract easily. However, in the case of impaction in the esophagus, it can lead to catastrophic conditions. Aorto-esophageal fistula is one such disastrous complication with a high fatality rate. Despite treatment, mortality rates of up to 80% have been reported in the literature, with the condition being uniformly fatal in untreated patients. We describe a case of aorto-esophageal fistula secondary to a chicken bone impaction presenting with sentinel hemorrhage and managed expeditiously and successfully with simultaneous endoscopic removal and surgical repair of the fistula.

Esophageal foreign body removal under holmium laser-assisted gastroscope: A case report.

As a common clinical emergence, esophageal foreign body can lead to esophageal perforation followed by severe complications including aortic injury, mediastinal abscess and airway obstruction, leading to a high rate of mortality. Therefore, fast and effective diagnosis and treatment are of great necessity. In this case, holmium laser-assisted gastroscopy was adopted to remove the foreign body incarcerated in the esophagus, allowing patients to avoid traumatic and costly surgeries. It is a supplement to traditional methods of foreign body removal. The new combination tried in this report can bring development and innovation inspiration to the development of endoscopic technology.