DOZ047.96: Esophageal food impaction presenting as life-threatening airway obstruction in children with esophageal atresia

Abstract

Abstract Objective An esophageal foreign body rarely presents as an apparent life-threatening event. However, in children with esophageal atresia, strictures and dysmotility can lead to severe food impactions. Given the underlying anatomy of children with esophageal atresia, a unique risk of severe impaction with resultant airway obstruction is possible. This study reports a case of a child in respiratory distress presenting after a choking event where endoscopy revealed near total tracheal compression from esophageal food impaction. Method Case discussion and review of literature are undertaken. Result A 3-year-old boy with trisomy 21 and history of esophageal atresia who had previously undergone successful repair was transported by helicopter after a choking episode. He was witnessed to have cough followed by apnea, cyanosis, and unresponsiveness, for which he underwent the Heimlich maneuver and required chest compressions for a respiratory arrest. He was immediately taken to the operating room for endoscopy with planned foreign body removal. Rigid bronchoscopy noted near complete obstruction of the airway from posterior tracheal wall compression with no airway foreign body. The airway was secured and a combination of rigid and flexible esophagoscopy subsequently extracted a large bolus of chicken. He was observed in the intensive care unit with no further respiratory event after extubation. Conclusion Esophageal dysmotility and strictures are common in children with esophageal atresia who have undergone repair. Mild airway symptoms are common in children with an esophageal foreign body; however, in children with esophageal atresia a high index of suspicion of an esophageal foreign body is requisite in the setting of acute airway obstruction.