Rigid Esophagoscopy Research Articles

Neglected foreign body in esophagus treated as chest infection: a case report

BackgroundEsophageal foreign body impaction is one of the common reasons of referral to Ear Nose Throat clinic. It is a medical emergency requiring urgent evaluation and treatment. Esophageal foreign body in a very young child can be a diagnostic challenge.Case presentationIn this case, we report an unusual sharp foreign body in the upper aerodigestive tract of a 20-month-old female child. It was neglected and misdiagnosed in the initial phase and was treated as a case of upper respiratory tract infection. Chest X-ray done was suggestive of a radiopaque irregular sharp foreign body at the level of the 6th cervical vertebra. The patient underwent rigid esophagoscopy on an urgent basis, and the foreign body was removed without any complication.ConclusionEsophageal foreign body in a very young child can mimic upper respiratory tract infection due to atypical symptoms. Strong witness history along with X-rays of the neck, chest, and abdomen help in making the immediate diagnosis. Clinicians should always advise parents for supervision of their children during play.

Removal of a Floating and Migrated Plate Screw in a Patient with a Failed Anterior Cervical Discectomy and Fusion

Anterior cervical discectomy and fusion (ACDF) is a commonly performed procedure for degenerative cervical spine disease. Rare complications of ACDF surgery include hardware failure, in the form of screw loosening and migration, or rod breakage. We present a case in which we removed a migrated screw lodged in the esophagus from a patient with a failed anterior cervical fusion. To present a surgical technique and considerations to remove a migrated screw. The previous ACDF incision was reopened and exposure was gained under the guidance of a head and neck surgeon. Longus coli were mobilized off the spine bilaterally with electrocautery. After dissection, the screw was found lodged in the longitudinal muscle of the esophageal wall and excised with the use of a 15-blade. The integrity of the esophageal mucosa and submucosa was maintained and subsequently checked with rigid esophagoscopy. Fluoroscopy was used to confirm that all hardware was removed, with the exception of the anterior cages. The dislodged screw, which was embedded in the esophagus, was successfully removed. Failure of an ACDF carries a risk of screw migration, which may be asymptomatic even if the screw is lodged in the esophagus. Additional considerations are required with potential violations of the adjacent viscera.

Late presentation of esophageal foreign body impaction, remaining from a car accident 40 years earlier: A case report

Background: The foreign body impaction (FBI) is an emergent medical condition caused by any object, material, or food trapped in the upper gastrointestinal tract, most commonly caused by swallowing, iatrogenic, or penetrating trauma. The cases reported in the literature are acute, commonly presenting within few days after the accident. As far as we are concerned, such a late presentation of an esophageal FBI has not been reported to date. Case Presentation: In this case report, we present a 67-year old male patient who was referred with severe dysphagia, recurrent fistula with sepsis, weight loss, malnutrition, and pulmonary aspiration. The history revealed a car accident 40 years ago with a penetrating wound in the neck. Rigid esophagoscopy was not possible, and the tip of car gear (3×4 cm) could be successfully removed by open surgical procedure with neck exploration. Conclusions: This case refers to the necessity of paying greater attention to the possible foreign bodies, which can remain from any accident, in order to prevent its complications caused by late diagnosis.

FLEXIBLE VERSUS RIGID ESOPHAGOSCOPY IN THE MANAGEMENT OF ESOPHAGEAL FOREIGN BODY IMPACTION

Background: Foreign body(FB) impaction accounts for 4% of emergency endoscopies in clinical practice. Flexible endoscopy(FE) is a recommended therapeutic option because it can be performed under local anesthesia, it is cost effective and is well tolerated. Rigid endoscopy (RG) under general anesthesia is another option and is advantageous in some circumstances. The aim of the study is to compare efcacy and safety of exible and rigid esophagoscopy in esophageal foreign body removal. Methods: It is a prospective study done in E.N.T department in KIMS MEDICAL COLLEGE, Amalapuram, which includes 50 patients with impacted foreign body esophagus. Parameters like type of foreign body, location of impacted foreign body are included. The study analyzies the type of procedure the patient have undergone, the intra operative and post operative complications. Results: This prospective cohort study includes 50 patients who have undergone surgical procedure for removal of impacted foreign body. Flexible esophagoscopy is performed in 30 patients and rigid esophagoscopy is performed in 20 patients . The most frequent complications are mucosal erosion, mucosal edema, and ulceration. Conclusion: Flexible esophagoscopy and rigid esophagoscopy are equally safe and effective for removal of impacted esophageal foreign body.

Three Cases of Foreign Bodies in the Hypopharynx and Esophagus Removed Using Sato Rigid Curved Laryngoscope

There are many cases of foreign bodies in the hypopharynx or esophagus that are removed using a flexible fiberoptic upper gastrointestinal endoscope, however, there are also cases in which, due to the shape and size of the foreign body and/or the anatomical problems, it is difficult to remove foreign bodies using a flexible fiberoptic endoscope. Conventional rigid esophagoscopy can sometimes be difficult due to the problem of a narrow visual field. In these case, the Sato rigid curved laryngoscope strongly lifts the larynx and provides a wide field of view and space at the entrance of the esophagus from the hypopharynx.

Suspension Microesophagoscopy: A Simple Diagnostic And Therapeutic Technique For Foreign Body In Esophagus.

Foreign body ingestion involving the paediatric age group is a common emergency referral encountered by Otorhinolaryngologists. The cervical oesophagus has been noted as the most prevalent site of impaction. Traditionally, a rigid oesophagoscopy would be required for examination under anaesthesia and removal of the foreign body is found, but this method may miss foreign bodies that are embedded into the mucosa, and faulty technique may result in perforation of the esophagus. Method and results: We present a suspension microesophagoscopy technique using a Lindholm laryngoscope and suspension to retract and suspend the opening of the oesophagus. Conclusion: This technique not only gives the surgeon an advantage to perform a two-handed procedure but also allows for a magnified examination of the oesophageal mucosa with the help of a rigid telescope for a thorough examination. The best diagnostic and therapeutic method for the management of foreign body in the oesophagus is examination under anaesthesia.Suspension microesophagoscopy can be done in the operation theatre with pre-existing instrument.This technique allows freedom for a two-handed technique.This technique gives a magnified visualisation of the mucosa revealing any embedded foreign body. The online version contains supplementary material available at 10.1007/s12070-022-03383-9.

Foreign Body Removal from Stomach: An Innovative Approach Using C-arm in ENT.

The ingestion of foreign body is a very common occurrence in pediatric age group. The retrieval is an emergency procedure performed mostly by the Otolaryngologist and Gastroenterologist. We present a case of coin ingestion who reported to a tertiary care center. It was retained in the lower part of esophagus as confirmed by imaging. Subsequently during the rigid esophagoscopy it was found missing from distal esophagus. A 9 year old female child presented with accidental ingestion of coin. The imaging done immediately prior to intervention confirmed position of coin in distal esophagus. However, up on visualization with rigid esophagoscope the coin was not found in esophagus and suspected to have passed in to stomach. We used C-arm to confirm the location which has its own limitations. There have been various case reports of using c-arm for tracing lost needles and broken instruments by oro-maxillo-facial surgeons. There are no reports where it has been used to aid foreign body removal fromgastro-intestinal tract. This is first case report where the use has been improvised due to lack of advanced facilities available at better and well equipped centers.The retrieval of foreign body from stomach aided by c-arm has not been reported in literature till now. The case report would add to the knowledge, options and practice at a center which does nothave any super speciality facilities.

Incidence of pediatric rigid esophagoscopy for foreign body removal before and after coin currency implementation in Saudi Arabia in 2017.

Foreign body (FB) ingestion is a common problem in children, which can lead to severe complications. Coins are the most common FB ingested. Since coin currency was recently implemented in Saudi Arabia, we decided to assess whether any changes have occurred in the incidence of FB removal by esophagoscopy. Incidence of rigid esophagoscopy for ingested FB removal before and after coin currency implementation. Medical record review SETTINGS: Main referral hospital in Jazan region. Our study included pediatric patients who underwent rigid esophagoscopy for removal of FB between February 2015 and July 2020 in the otorhinolaryngology department. We reported the incidence, age, gender, and type of FB. As the coin currency implementation started on December 2, 2017, the data were analyzed before and after this date. Annual incidence of pediatric rigid esophagoscopy for removal of ingested FB and type of the FB. 124 patients RESULTS: The median age and interquartile range was 6.0 (5.0) years. After implementation of coins in 2017, 104 cases were reported over 32 months; before that date, 20 cases were reported over 34 months. Coins were the FB in 2 cases (10%) before implementation of coins and in 83 cases (79.8%) after implementation (P=.0001). The annual incidence of pediatric esophagoscopy for FB removal has increased more than five times since implementation of coin currency. This increase is exclusively related to the increase in coins as a FB. Retrospective study. None.

A Rare Foreign Body in a Patient with Poor Dentition: A Satay Skewer

Foreign body (FB) ingestion and impaction in the upper gastrointestinal tract is a common urgent referral to otorhinolaryngology. The types of FB are significantly different between children and adults, and it largely depends on the region, sociocultural influences and dietary habits of the patient. Rare FBs in adults should be suspected in certain groups of people with psychiatric illnesses and in patients with dental pathology who are unable to chew food properly before swallowing. In this report, we present a rare case of oesophageal impaction by a long satay skewer with sharp ends along with chicken meat in a 37-year-old man with poor dentition. It was successfully removed using rigid oesophagoscopy.

Cricoid cartilage ossification confuse as an oesophageal foreign body: a case report

<p class="abstract">Ossification of laryngeal cartilages usually begins at the age of 20 years in males and at the age of 22 years in females. Ossification in the cricoid cartilage begins from behind to forward. Oesophagus is one of the most common sites for the foreign body. The most common cause of impaction in adults is a meat bolus. A case of 37 years female presented with feeling of pricking sensation in the throat after eating chicken meat which was associated with difficulty in deglutition. X-ray of the neck in antero-posterior view and lateral view was done which showed radio-opaque shadow in front of C6 vertebrae. Rigid oesophagoscopy under general anesthesia was done based on clinical and radiological findings. On rigid oesophagoscopy, foreign body was not seen except minimal injury on the mucosal wall which was 15 cm from the upper incisors. What we can conclude from our case is that, it is always better to confirm a diagnosis of suspected foreign oesophagus with a CT-Scan or Upper GI endoscopy if available to avoid an unnecessary interventions and suffering of patients.</p>

THYROHYOID LIGAMENT CALCIFICATION MIMICKING FOREIGN BODY ESOPHAGUS; A RARE CASE REPORT AND REVIEW OF THE LITERATURE

Background: Foreign body ingestion frequently occurs in the extreme of ages. Meat bolus, fishbone buried in the food, and sharp bone are the common ingested foreign bodies among adults. The normal ligament and bony structure start to ossify after the third decade of life and mimic foreign bodies. Ossified thyrohyoid ligament, cricothyroid ligament, cornu of hyoid bone may be misdiagnosed as a foreign body in the aerodigestive tract. Case presentation: We describe a 54 years female who presented with painful swallowing for two days after eating chicken bone at Emergency Department. X-ray soft tissue neck lateral view showed a radiopaque shadow in front of the C3-C4 region. The patient underwent rigid esophagoscopy, however, a foreign body could not be found at the pharynx. Computerized Tomography (CT) shows the same hyperdense shadow at the same location as seen in the x-ray. Furthermore, Magnetic resonance imaging (MRI) scan was done to localize the exact site of the foreign body, but the patient was a case of thyrohyoid calcification rather than foreign body in the esophagus. Conclusion: Difficulty arises for the surgeons when a foreign body is not found during rigid esophagoscopy. It is important to reassess and locate the foreign body by imaging. The calcified ligament can mimic a foreign body in the neck. MRI confirms the diagnosis which may be misguided by X-ray and CT-scan.

A neglected foreign body in oesophagus with an unusual presentation: a case report

<p>Foreign body ingestion is clinical emergency in otorhinolaryngology practice which requires immediate proper management to ensure speedy recovery and reduce complications. Accidental ingestion of food based foreign bodies like fish and meat bones are common among adults. Penetration of these foreign bodies may cause vascular or suppurative complications which are rare; however, if present these can cause significant morbidity to the patient. We report a case of 60-year-old male patient who presented with painful right side neck swelling. The CT nscan neck revealed a foreign body penetrating oesophageal wall on either side leading to right cervical abscess and mediastinitis. Under general anaesthesia foreign body bone piece was removed by rigid oesophagoscopy. In conclusion, it is very important to elicit the history of accidental foreign body ingestion in patients who present with acute onset of neck swelling. Besides clinical examination, radiological imaging modalities are very useful in confirming the diagnosis, site localisation of foreign body and proceed with timely and appropriate management.</p>

A Case of Foreign Body Esophagus in a Six Year Old Child Previosly Operated for Esopageal Atresia: The Anesthetic Management

Foreign body ingestion is quite common in the pediatric age group. A six year old boy was brought by his parents to the hospital with history of foreign body (marble) ingestion. The child had been previously operated for the esophageal atresia. Imaging revealed a foreign body of 1.5cm size in the esophagus at the atretic part. The foreign body removal was initially attempted via rigid esophagoscopy but could not succeed. Hence, the procedure was changed to right thoracotomy for foreign body retrieval in the same sitting. Patient also had intraoperative itragenic trachea-esophageal fistula formation. General anesthesia was planned using single lumen cuffed ETT of 5.0mm ID for ventilation. Caudal catheter was inserted for postoperative pain management and early recovery following thoracotomy. Such cases of foreign body ingestion in an atretic esophagus should always be planned considering the unexpected extend of surgical procedure and peri-operative complications.

A Retrospective Study of Oesophageal Foreign Bodies using Rigid Oesophagoscopy from Mandya, Karnataka, India

Introduction: Foreign bodies in the oesophagus is one of the commonly seen conditions in the Department of OItorhinolaryngology. Aim: To describe the clinical features and time delay of patients presenting with oesophageal foreign bodies. Materials and Methods: Present study was a retrospective study of case records of 60 patients who underwent rigid oesophagoscopy for foreign body removal at Mandya Institute of Medical Sciences Mandya, Karnataka, India, from January 2017 to December 2019. Details like age and sex of the patient, presenting symptoms, time delay in presentation to the hospital, the type of foreign body ingested, location of the foreign body in oesophagus, any complications were noted in a detailed case proforma. Preoperative X-ray of neck and chest was done in all patients. Descriptive statistical tests like percentage and mean were used to analyse the data. Results: Out of 60 patients, 36 (60%) were children and 24 (40%) patients were adults. Coin was the most common foreign body seen in children (n=32/60, i.e., 53.3%) whereas meat bone was the most common foreign body in adults (n=16/60, i.e., 26.6%). Forty two patients out of 60 presented within 24 hours of foreign body ingestion. Two patients presented after 72 hours of foreign body ingestion. Thirty one patients presented with foreign body sensation in throat, dysphagia was present in 21 patients and two patients presented with fever. Two patients who presented more than 72 hours after foreign body ingestion had mucosal oedema on rigid oesophagoscopy. There was mucosal injury in four patients intraoperatively, two were with dentures, one was with button battery and the other was with a sharp metal locket. Conclusion: Coin was the most commonly seen foreign body in children whereas meat bolus with or without bone was most commonly seen in adults. Timely diagnosis and early removal of the foreign body should be done to prevent complications.

A migratory sharp foreign body from the hypopharynx to the deep neck space – A case report

Foreign body (FB) ingestion is a common emergency managed by otorhinolaryngologists. The clinical manifestations and management vary as per the site of FB and its complications. The diagnosis of FB ingestion is often challenging and depends on its clinical presentations and imaging. One of the rare complications of FB ingestion is migration, which has the potential to result in morbidity and mortality. Migration of FB is said to have occurred in the presence of negative rigid esophagoscopy and positive radiography. Migration of FB to the neck requires neck exploration for its successful removal. Here, we report a case of sharp FB ingested, which penetrated through the hypopharyngeal wall by its sharp end and migrated into the deep space of the neck.

A Coin and Something Else: A Rare Case Report

Foreign body ingestion in children is considered an emergency. The most common ingested foreign bodies are coins; however, the ingestion of disc batteries is on the rise requiring urgent rigid esophagoscopy. In the literature, multiple foreign body ingestion is very rare and only a few cases of multiple coins and multiple battery ingestion have been reported in the past. Herein, a case of simultaneous coin and battery ingestion requiring foreign bodies removal on two sequential endoscopies due to improper initial evaluation in a pediatric patient is reported which, to our knowledge, is the first reported case.

Migrated and Impacted Foreign Body of Retropharyngeal Space: A Case Report.

Foreign body upper aerodigestive tract is a common presentation but foreign body migrating into retropharyngeal space is not only uncommon, but its management also differs and is challenging too. Here we present a case of a foreign body migrating into the retropharyngeal space which was removed intraorally. A 28- year old male patient presented with complaints of pain while swallowing following consumption of sausage and pork two days earlier to the onset of symptoms. X-Ray Neck AP and lateral view were done which revealed a thin metallic foreign body at the level of the T4 vertebra. Upper gastrointestinal endoscopy and rigid esophagoscopy were done in which a foreign body was not visualized in the esophageal lumen. NCCT neck was done which gave precise location and was removed intraorally with the patient in Rose position. A repeat x-ray was done on the 5th day which revealed no foreign body, the patient was discharged on the 7th day. Although the upper aerodigestive tract foreign body is common, foreign body migrating to the posterior pharyngeal wall or into the retropharyngeal space is not common and it is difficult to remove a migrated foreign body many cases requiring open procedures, thoracoscopy, thoracotomy.

ESOPHAGEAL IMPACTION OF FERTILIZED DUCK EGG ALBUMEN (HARDENED BALUT WHITE) IN A TERTIARY GOVERNMENT HOSPITAL IN THE PHILIPPINES: A CASE SERIES

Background: This study described the clinical profile of patients who developed esophageal impaction after ingesting the hardened white portion (albumen) of a fertilized duck egg (colloquially termed balut).
 Methods: A review of patients with foreign body impaction of hardened balut egg white was performed. These patients were admitted in the emergency room from November 2013 to November 2018. Clinical features analyzed included age, sex, clinical signs and symptoms, imaging performed, operative findings and complications.
 Results: In all, 18 patients were included in the review. Seventeen were male with a majority in the 20- to 40-year-old age range. Dysphagia and neck tenderness were the most commonly presented symptoms and physical examination finding, respectively. Twelve cases were successfully extracted via rigid esophagoscopy under general anesthesia, while one case was resolved through spontaneous ejection. The most common site of impaction was at the cervical esophagus. One third of patients undergoing extraction had minor noncircumferential esophageal abrasions.
 Conclusion: Ingestion of the entire hardened balut white can lead to esophageal impaction, necessitating admission and operative management. Young males are commonly affected. Due to its intrinsic characteristics as a foreign body, its removal can prove challenging. Push technique and extraction (both via piecemeal and wholly) were found to be effective, and when performed correctly, minimized complications. Nevertheless, this condition may be prevented with health education.

Emergency management of jujube pit esophageal impactions using rigid esophagoscopy in the aged.

ObjectiveTo study the emergency management of esophageal jujube pit ingestion.Study DesignRetrospective case series.MethodsA retrospective study of 114 consecutive cases of jujube pits esophageal impaction during 3 months was performed.ResultsOne hundred and fourteen cases were confirmed as jujube pit esophageal impaction using contrast‐enhanced radiography. All jujube pits were retrieved using rigid esophagoscopy under general anesthesia as outpatients, except one case where a direct laryngoscope was used. In four cases, esophageal perforation was found, the patients were treated with conservative measures, and none died.ConclusionJujube pit esophageal impaction is characterized by a high incidence of perforation. The conservative management of cervical perforation is effective in this study. Rigid esophagoscopy under general anesthesia is safe for jujube pit esophageal impaction.Level of Evidence4.

The effect of a statewide prescription drug monitoring program on opioid prescribing patterns

PurposeDetermine whether opioid prescribing patterns have changed as a result of implementation of a prescription drug monitoring program (PDMP) in the state of Massachusetts. Materials and methodsA multicentered retrospective study was performed including patients who received tonsillectomy, parotidectomy, thyroidectomy or direct laryngoscopy and biopsy with or without rigid esophagoscopy and/or rigid bronchoscopy at Lahey Hospital and Medical Center (Burlington, MA) or Boston Medical Center (Boston, MA). Opioid prescribing patterns were compared for the 12 months prior to implementation of the Massachusetts Prescription Awareness Tool (MassPAT) to 36 months of prescribing patterns post implementation. Quantity of opioids prescribed was based on morphine milligram equivalents (MME). Continuous variables were compared using analysis of variance (ANOVA) while categorical variables were compared using chi-squared test or Fisher's exact test. Multivariate analysis was performed using linear regression. ResultsA total of 2281 patients were included in the study. There was a significant association in mean overall MME prescribed comparing pre-MassPAT and post-MassPAT data [tonsillectomy: 635.9 ± 175.6 vs 463.3 ± 177.7 (p < 0.0001), parotidectomy: 250.4 ± 71.33 vs 169.8 ± 79.26 (p < 0.0001), thyroidectomy: 186.2 ± 81.14 vs 118.3 ± 88.79 (p < 0.0001), direct laryngoscopy with biopsy: 308.3 ± 246.9 vs 308.3 ± 246.9 (p = 0.0201)]. There was also a significant association between length of opioid prescription (days) and implementation of MassPAT, but there was no significant difference in the percent of patients requiring refills pre- MassPAT and post-MassPAT. ConclusionThis study demonstrates that prescribers have been able to significantly decrease the amount of opioids prescribed for tonsillectomy, parotidectomy, thyroidectomy, and direct laryngoscopy and biopsy and patients have not required additional opioid refills.