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.