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Arch Dis Child doi:10.1136/archdischild-2012-303230
  • Images in paediatrics

Oesophageal foreign body presenting with stridor associated with feeding

  1. Malcolm Brodlie1,2
  1. 1Department of Paediatric Respiratory Medicine, Great North Children's Hospital, Newcastle upon Tyne, UK
  2. 2Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
  1. Correspondence to Dr Malcolm Brodlie, c/o Paediatric Respiratory Secretaries, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK; m.j.brodlie{at}ncl.ac.uk
  • Received 18 October 2012
  • Revised 27 November 2012
  • Accepted 24 December 2012
  • Published Online First 17 January 2013

A 19-month-old girl was referred with intermittent biphasic stridor that occurred after feeding. The stridor was first noted at the age of 9 months, coinciding with the introduction of more solid weaning foods. There was a history of a choking episode while playing with a polystyrene toy plane around this time. After the episode, she was assessed acutely at her local hospital and discharged following a normal chest radiograph and examination. Feeding problems then progressed over time with regurgitation of solid foods along with stridor after feeding.

She was reviewed in a clinic and listed for examination of her airway under general anaesthesia. Flexible bronchoscopy identified compression of the mid-trachea. Rigid oesophagoscopy revealed a foreign body (figure 1) that was removed. An oesophageal contrast study postremoval (figure 2) showed a small pouch with no evidence of leak that was managed conservatively. The stridor resolved completely and there has been a gradual reintroduction of a normal solid diet.

Figure 1

(A) Presence of a rigid rectangular, thin foreign object in the oesophagus. (B) Granulation tissue and swelling of mucosa following removal. (C) Removed foreign body.

Figure 2

Upper gastrointestinal contrast study showing an oesophageal pouch at the T1–T2 level.

Possible foreign body aspiration or ingestion is a common cause for attendance to acute paediatric services.1 A substantial majority of ingested foreign bodies pass spontaneously through the gastrointestinal tract uneventfully.2 In children, where foreign bodies lodge in the oesophagus, respiratory symptoms are common, however, and have been reported in up to 72% of cases.2–4 The incidence of complications increases with the duration of foreign body impaction and both oesophageal and tracheal damage may occur.5 ,6 In this case, an oesophageal diverticulum was identified at the site of the foreign body on the postremoval contrast study. The investigation will be repeated in a few months’ time with a low threshold for a repeat oesophagoscopy if there are any ongoing concerns. It is impossible to be certain if the diverticulum is secondary as a result of the chronic foreign body or whether it is a congenital abnormality that may have actually caused a predisposition for the foreign body to lodge at this site. We recommend careful consideration of the need for postoperative oesophageal imaging in each individual case to rule out any acute or chronic oesophageal pathology.3 ,6

In summary, the diagnosis of radiolucent foreign bodies can be challenging and careful history taking is important, with a low threshold for further investigation if clinical suspicion arises.

Acknowledgments

We are grateful to Mrs Anne Lawson and Mr Hany Gabra, Consultant Paediatric Surgeons, and Mr Gerry Siou, Consultant Ear Nose and Throat Surgeon, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, for their valuable input to this case.

Footnotes

  • Contributors ZYL wrote the first draft. MCM, JT, CJO and MB were involved in the care of the patient and contributed to the subsequent drafts of the manuscript.

  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

References

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