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.