Asymptomatic esophageal perforation by a coin in a child

Ingestion of coins by children is a common event that rarely causes serious complications. We present a case of asymptomatic esophageal perforation by a penny in a child who presented with wheezing six months after the ingestion. When esophagography and triple endoscopy failed to show the perforation, thoracotomy resulted in successful removal of the foreign body, which was encased in granulation tissue between the trachea and esophagus. Complications of foreign body ingestion are discussed.     

Fatal aspiration pneumonia caused by an esophageal foreign body

Esophageal foreign body accompanied by respiratory complications is a rare condition. A few cases have been reported, only two of them in adults. We describe the case of a 34-year-old mentally retarded patient who was hospitalized for aspiration pneumonia and died 48 hours after admission. At autopsy, the prominent finding was a 3 X 3-cm stone impacted into the upper esophagus and compressing the trachea from behind. The possibility of an esophageal foreign body should be included in the differential diagnosis of unexplained respiratory distress or aspiration pneumonia in adults.     

Esophageal foreign bodies: 177 cases

The aim of this study is to assess patients treated for esophageal foreign bodies. The charts of patients (n = 177), between January 1994 and April 2009, were investigated retrospectively. Patients' age and gender, locations and types of foreign bodies (FBs) and interventions were taken into consideration. Fifty‐seven percent of the patients were male. The youngest patient was 6 months, whereas the oldest was 83 years old. The median age was 9 years. Half of the patients were in their first decade. Treatment took place 11 h (ranging from 1 to 120 h) after impaction of the FB. One hundred fifty‐two FBs were removed in 177 patients. Our negative esophagoscopy (n = 25) rate was 14%. The FBs were radiopaque in 75% (n = 114) and were commonly (71%; n = 109) located in the cervical esophagus. Metallic coins (n = 81–53%) were the most commonly observed inorganic FB while bones and/or meat impaction (n = 54–35%) were the most frequent organic FB. A total of 182 endoscopic interventions were performed on these patients. One hundred eleven of them were esophagoscopy and the remaining 71 were direct laryngoscopy. The FB was pushed into the stomach in 11 patients. Our morbidity rate was 1.6% (n = 3). Iatrogenic perforation occurred in two patients. There was no mortality. Esophageal FBs may vary in type: sharp or round objects, metallic, plastic or organic material. FBs are commonly found at pharyngoesophageal junction and usually removed by McGill forceps. Rigid esophagoscopy is used for children and adults because of its large working channel. Rigid instruments are considered reliable and safe for extracting foreign bodies.     

Foreign bodies in the esophagus. A study of causative factors

Two hundred and twenty-nine patients were studied in an attempt to determine the main causative factors behind their having a residual foreign body in the esophagus. Strictures were present in 13%. Fifty-two percent of the patients with stricture had been hospitalized more than once for treatment of foreign body impaction; this was the case in only 8.5% of the rest of the patients (p<0.001). More than half of the patients aged 15 years or younger had a foreign body in the hypopharynx. This location was extremely uncommon in adults (p<0.001). The hypothesis of spasm distal to an esophageal foreign body as the cause for obstruction in patients without esophageal stricture was supported by the following findings: spontaneous disimpaction occurred in more than one-third of the patients and became more frequent as time progressed; 63% of 16 patients given spasmolytic drugs experienced spontaneous disimpaction of the foreign body; half of the patients had the foreign body in the proximal esophagus distal to the narrower passage of the upper esophageal sphincter; foreign body impaction in the esophagus turned out to be a once-only event in 86% of the patients; and 21% of the patients had a disorder of the central nervous system and had been hospitalized significantly more often because of food impaction than the other patients. The findings indicate that adults with a history of impaction of foodstuff lacking sharp bones and who do not have stricture suffer food impaction because of spasm of the esophageal smooth muscle, and can be treated accordingly.     

Treatment of cervical esophageal perforation caused by foreign bodies

In this article, we reviewed our experience of treatment of cervical esophageal perforation caused by foreign bodies. Between 1980 and 2010, 42 patients were included in this study. There were 18 women and 24 men with a median age of 54 years. We divided the patients into three groups: the patients whose foreign bodies could not be extracted by otolaryngologists using endoscope (n= 7), the patients who had some signs of abscess formation but the foreign bodies had been extracted using endoscope (n= 25), and the patients who had no signs of abscess formation and the foreign bodies had been extracted (n= 10). We treated the patients of the three groups with surgical treatment, drainage alone, and conservative treatment, respectively. The outcome of the current series was favorable. Our experience suggested that most of the cases can be treated conservatively or by drainage alone. If the foreign bodies of the esophagus could not be extracted using endoscope, surgical treatment including the removal of the foreign bodies, primary repair, and drainage should be performed.     

Endoscopic management of suspected esophageal foreign body in adults

Foreign bodies should not be allowed to remain in the esophagus beyond 24 hours after presentation. However, some patients with esophageal foreign body ingestion do not come to the hospital immediately and may delay medical intervention from the time of ingestion. The aim of this study was to investigate the outcomes of adults with suspected esophageal foreign body ingestion according to the time of ingestion and types of foreign bodies. A total of 326 adult patients (151 men and 175 women) were analyzed, and divided into two groups according to the time period: within or beyond 24 hours from ingestion to endoscopic intervention. A total of 172 patients (52.7%) were found to have ingested foreign bodies; 73.5% were removed smoothly, 10.3% were treated by push technique and 16.0% with failed retrieval received alternative treatments. A higher proportion of patients in the beyond‐24 hours group suffered from odynophagia (25.9 vs. 12.9%, P < 0.05). Negative identification of esophageal foreign bodies was more frequent in the beyond‐24 hours group (67 vs. 40.2%, P < 0.05), but these patients showed higher proportions of esophageal ulcers (21.1 vs. 7.2%, P < 0.05). The beyond‐24 hours group also showed a significantly higher rate of foreign bodies in the lower esophagus (40.0 vs. 15.3%, P < 0.05). Patients with esophageal food bolus impaction had significant delayed endoscopic intervention, longer therapeutic endoscopic time, higher proportions of esophageal cancer, stricture and fewer complications. Endoscopic intervention within 24 hours from the time of ingestion should be considered early in adults, because delaying intervention may produce more symptomatic esophageal ulcerations with odynophagia.     

新型内镜扩张球囊在上消化道异物取出中作用研究

目的探讨一种新型内镜扩张球囊取出上消化道异物的安全性并评估其疗效。方法收集2018年7月至2019年3月收治于苏州大学附属第一医院经传统方法取出失败的10例上消化道异物患者的临床资料,其中食管异物8例,胃石2例,内镜扩张球囊辅助胃镜取出异物,观察操作成功率、异物取出所用时间、视野清晰度、黏膜损伤及并发症等情况。结果10例患者中,5例颈段异物顺利取出;3例胸段异物中,1例位于左锁骨下动脉附近(约5.0 mm),局部麻醉下取出;1例位于主动脉弓附近(约3.5 mm),静脉麻醉下取出;1例位于主动脉弓附近(约1.9 mm),在介入联合气管插管下取出;2例胃石,均为BillrothⅠ术后,1例通过取石网篮、圈套器顺利取出;另1例胃石排入小肠出现肠梗阻,行手术取出。所有患者均未造成二次损伤。结论内镜扩张球囊辅助胃镜取出上消化道异物具有较高的安全性,尤其对于常规方法无法取出的异物,避免了直接取出时的二次损伤。其操作简单、实用、并发症少,具有较好的临床推广价值。     

Anesthesia and airway managements for emergency removal of esophageal foreign body in a trisomy 21 patient with mental retardation and predicted difficult airway: A case report

Introduction:The typical manifestations of patients with a trisomy 21 syndrome are mental retardation and anatomical deformities of face and neck. In the available literature, all case reports regarding anesthetic management of mentally retarded patients have focused on elective surgeries. There is no report regarding anesthetic management of mentally retarded patients undergoing emergency surgery.Patient concerns:A 47-year-old woman with a mental retardation grade 2 by trisomy 21 syndrome suffered from an esophageal foreign body for 3 days and needed emergency removal of esophageal foreign body. The patient had a poor cooperation and obvious anatomical abnormalities of head and neck.Diagnoses:Difficult anesthesia and airway managements for emergency removal of esophageal foreign bodies in a trisomy 21patients with mental retardation and predicted difficult airways.Interventions:Combined use of an intubating supraglottic airway and the flexible bronchoscope-guided intubation after intravenous anesthesia induction.Outcomes:Effective airway was safely established and an esophageal foreign body was successfully removed by rigid esophagoscopy under anesthesia. The patient recovered smoothly without any complication.Lessons subsections as per style:When general anesthesia and emergency airway management are required in the patients with mental retardation and predicted difficult airways, a combination of the supraglottic airway and the flexible bronchoscope maybe a safe and useful choice for airway control.     

Multiple projectile injuries secondary to motorized lawn edger use

A case of projectile injuries secondary to lawn edger use is presented. A 32-year-old man was seen in the emergency department with the complaint of bilateral shoulder pain and initially without a history of trauma. When small scars were noted at the sites of pain, a history was elicited of possible injury six months previously while using a gasoline-powered lawn edger. Radiographic evaluation revealed bilateral wire missiles embedded in soft tissue. These were later removed uneventfully.     

Endoscopic Management for Delayed Diagnosis of a Foreign Body Penetrating the Esophagus into the Lung

A 31-year-old male presented with chest pain started after eating chicken about 2 weeks earlier. Upper endoscopy and Computed tomography scan of the chest revealed a sharp chicken bone penetrating the esophageal wall into the right lung. The foreign body was removed endoscopically using a rat-tooth forceps, followed by prophylactic placement of a metal stent across the esophageal perforation site. Foreign body-induced perforation is one of the common etiologies of benign esophageal perforations. Although the primary treatment is surgery, endoscopic therapy may be appropriate in individualized cases like our patient.     

成人下呼吸道异物20例临床分析

目的总结及分析成人下呼吸道异物的临床特点,评价纤维支气管镜(纤支镜)对下呼吸道异物的诊治价值。方法回顾性分析本院近12年收治的成人下呼吸道异物患者的临床资料。结果其中男16例、女4例;年龄28～73岁;左侧2例,右18例。12例明确下呼吸道异物;8例误诊,误诊率40%。在常规纤支镜检查确定为异物后使用异物钳分别对20例患者下呼吸道的异物进行钳取,均获得成功,治愈率达100%,无1例出现并发症。结论部分患者因病史诉说不清,临床缺乏特异性,易误诊为其它呼吸系统疾病,纤支镜可作为对下呼吸道异物诊断和钳取的重要工具,具有重要价值。     

A subglottic foreign body mimicking croup: A case report

Introduction:Foreign body (FB) aspiration is one of the causes of respiratory distress in infants is an extremely dangerous and potentially life-threatening event. The diagnosis of FB aspiration is difficult because the signs and symptoms vary according to the degree of airway blockage or location of the FB.Patient concerns:An 11-month-old female infant visited a hospital because of a sudden onset cough. She was relatively healthy without fever, rhinorrhea cyanosis, or poor feeding. On physical examination, auscultation revealed inspiratory stridor without wheezing and crackles.Diagnosis:Croup was suspected when considering the history, physical examination, and imaging. However, she did not respond to a 4-day course of treatment for croup. Flexible laryngoscopic examination was performed, and we identified a thin, flat, and sharp FB embedded in the subglottic region.Interventions:Emergency surgery was performed to remove the FB. Short-term intravenous corticosteroids and antibiotics were used to prevent laryngeal swelling and aspiration pneumonia.Outcomes:One week after the procedure, the laryngeal mucosa had completely healed.Conclusion:FB aspiration should be considered in an infant with an impression of croup. In particular, if there is no response to medical or conservative treatment for croup, further evaluation is needed.