DISCUSSION
Lodged foreign body in aero-digestive tract of children is one of the
frequently observed conditions in pediatric emergency department. Its
incidence is equal in both the genders.8 Children can
swallow myriad of objects due to easy accessibility of objects like
coins, toys , batteries and jewelries in households.
The vast majority of smaller smooth ingested foreign bodies will pass
spontaneously via gastrointestinal tract without any damage. However,
certain foreign bodies may lodge in areas of normal narrowing or
curvatures of esophagus most commonly in upper esophagus i.e.,
cricopharynx. 9
Among this FB that comes to clinical attention, 80%-90% pass through
gastrointestinal tract (GI) without causing any harm. Another 10%-20%
require a careful manipulation for endoscopic removal, with
<1% of foreign objects require open surgical
exploration.5
Usually FB ingestion/inhalation presents with excessive drooling, poor
feeding, dysphagia and vomiting and occasionally cough, stridor and
wheezing. Respiratory symptoms secondary to esophageal foreign body in
not uncommon presentation which is likely to be seen in a case where FB
are sharp, irregular and is of large size.10
In our case, due to the large size of metallic container, it got lodged
in the oropharynx as the child was not able to swallow it completely.
The foreign body showed sharp edge towards the hollow surface. Notably,
the sharp or jagged foreign body carries significant morbidity and
mortality as they are responsible for 15% to 35% of perforations
following ingestion.11
Mostly, lodged foreign body in aero-digestive tract of child is
suspected when one refuses to eat or has excessive drooling and noisy
breathing. However, at times there will be more straight forward
diagnosis when family member reports to have witnessed the ingestion of
the foreign body like in our case.
Child suspected with ingested foreign body requires minimal laboratory
investigations. Antero- posterior and lateral X-ray including neck,
thorax and abdomen should be obtained in patients with the complaints of
FB ingestion or suspicion of ingestion.12
Sometimes in a suspicious case of FB ingestion/inhalation among the
unattended child, X-ray nasopharynx is also required wen X-ray neck and
chest is inconclusive. However, the ingested/inhaled FB lodging in
nasopharynx as rarely been reported.13
Foreign body located in esophagus can be removed via flexible or rigid
esophagoscopy or hypopharyngoscopy. Likewise other techniques like
Penny-pincher technique, Foley catheter extraction, esophageal
bougienage and removal with Magill forceps have been used for removal of
esophageal foreign body .14
In this case, a 13 month-old-girl presented with excessive drooling and
noisy breathing with direct documented history of ingestion of a
metallic container. Radiography revealed radiopaque vertically oriented
circular foreign body in the region of oropharynx and hypopharynx. Under
general anesthesia and direct laryngoscopy, safe removal of large
circular metallic object was performed via Freer’s elevator and Magill’s
forceps.