2. CASE REPORT
A 13-month-old female child presented to the Emergency Department of
Patan Academy of Health Sciences (PAHS) Nepal, with an alleged history
of accidental ingestion of large circular metallic object 1.5 hours back
while playing with the same following which child had excessive drooling
and noisy breathing. On physical examination, the child’s pulse was
120/min, BP 70/50 mm of Hg, and respiratory rate of 40/min. She showed
signs of inspiratory stridor and decreased air entry while lying flat. A
foreign body in aerodigestive tract was suspected; thus, X-ray soft
tissue neck anterior-posterior (AP) and lateral was requested which
revealed a radio-opaque, vertically oriented circular foreign body in
the region of oropharynx and partly extending upto naso-hypopharyngx.
(Figure 1A and B). Physical examination revealed no other significant
abnormalities.
Thus, rigid endoscopy (hypopharyngoscopy) was subsequently planned under
general anesthesia. In the operating room child was sedated and while
intubating, huge metallic container was seen which was occupying whole
of the oropharynx and inferior part of nasopharynx with sharp margin
facing anteriorly causing partial airway obstruction. . Intubation was
difficult due to large size of foreign body. Further, downward
manipulation was also risky due to risk of falling down to hypopharynx
and getting flipped to cause the complete airway obstruction.
Tracheostomy set was kept ready. Eventually after direct laryngoscopic
visualization and careful manipulation of FB was removed by Freer’s
elevator and Magill’s forceps without any trauma to soft palate or
posterior pharyngeal wall. Uvula however appeared grossly edematous. On
inspecting the foreign body it was a huge (2.5x2.5cm) metallic hollow
circular 0.7 cm deep container having sharp edge and mirror on opposite
surface. (Figure 2A &B) Child was immediately intubated after the
procedure to secure the airway and was admitted to the pediatric
intensive care unit. The following day, child was asymptomatic and was
transferred to pediatric ward. She was discharged on third postoperative
day and was doing absolutely fine on scheduled follow up after a week.