Clinical Case Report: Sharp Foreign Body of Difficult Extraction Located in Hypopharynx

Abstract

INTRODUCCION: Los cuerpos extranos alojados en faringe representan problemas clinicos urgentes, que afectan sobre todo a la poblacion pediatrica y de adultos mayores. Solo el 10-20% de casos son complejos y requieren intervenciones no quirurgicas (endoscopia) y menos del 1% necesitan cirugia. La mayoria de cuerpos son de origen alimenticio y varian entre las diferentes regiones y culturas. Debido a la situacion anatomica de la hipofaringe y su cercania a la laringe y al esfinter cricofaringeo, la extraccion de objetos tiene una alta tasa de exito mediante endoscopia flexible. Sin embargo, cuando el tratamiento de primera eleccion falla, los laringofaringoscopios curvados de tipo rigido pueden ser utilizados por su capacidad de mostrar ampliamente la hipofaringe mientras se previene el dano mucoso o perforacion faringea.CASO CLINICO: Paciente femenino de 57 anos, acudio a emergencias por moderada odinofagia, disfagia a solidos y sensacion de cuerpo extrano intraluminal en cuello, secundarios a ingesta accidental de espina de pescado. La paciente no indicaba tos ni dificultad respiratoria. Se realizo tomografia computarizada de cuello sin contraste que evidencio objeto hiperdenso de 31 mm de largo x 2 mm de ancho, ubicado en forma oblicua en hipofaringe. EVOLUCION: A las 38 horas de hospitalizacion, se decidio realizar una endoscopia digestiva alta, que extrajo fragmentos pequenos, fallando su extraccion total. Se decidio posteriormente el uso de un laringofaringoscopio curvo rigido, para movilizar y extraer el cuerpo extrano de manera atraumatica.CONCLUSION: A las 38 horas de hospitalizacion, se decidio realizar una endoscopia digestiva alta, que extrajo fragmentos pequenos, fallando su extraccion total. Se decidio posteriormente el uso de un laringofaringoscopio curvo rigido, para movilizar y extraer el cuerpo extrano de manera atraumatica. ABSTRACT BACKGROUND: Foreign bodies located in the pharynx are considered medical urgencies, affecting mainly pediatric population and older adults. Only 10 - 20% of cases are complex and require non-surgical interventions (endoscopy) and less than 1% need surgery; the majority of foreign bodies are food derivatives. Due to the anatomical situation of the hypopharynx and its proximity to the larynx and the cricopharyngeal sphincter, the extraction of foreign bodies through flexible endoscopy has a high success rate. However, when the first-choice treatment fails, rigid-type curved laryngopharyngoscopy can be used because of its capacity to widely show the hypopharynx while preventing mucosal damage or pharyngeal perforation.CASE REPORT: 57-year-old female patient, who complained of moderate odynophagia, dysphagia to solids and intraluminal foreign body sensation in the neck, secondary to accidental ingestion of a fishbone. The patient denied cough or respiratory distress. Computed tomography of the neck without contrast was performed, which showed an hyperdense object that measured: 31 mm long x 2 mm wide, located obliquely in the hypopharynx.EVOLUTION: Within 38 hours of hospitalization, upper gastrointestinal endoscopy was performed, taking out small fragments, without complete extraction. A rigid curve laryngopharyngoscopy was performed with the extraction of the foreign body without producing any damage.CONCLUSION: Foreign bodies impacted in the hypopharynx need an evaluation and individualized clinical management. The use of the rigid curved laryngopharyngoscope is recommended as an alternative in case of objects that couldn’t be extracted by endoscopy and when surgery cannot be performed.