Unusual Presentations of Penetrating Foreign Bodies of the Upper Aerodigestive Tract

Abstract

Only a small number of ingested foreign bodies perforate the esophagus and even a smaller fraction migrate extraluminally. Four such penetrating and migrating foreign bodies of the upper aerodigestive tract are presented. Review of the literature revealed 321 cases of penetrating ingested foreign bodies, of which 252 remained intraluminal and 43 were found extraluminally, with the status of the remainder indeterminate. Analysis revealed that an intraluminal penetrating foreign body carried a higher overall mortality than one that migrated extraluminally. Although intraluminal and extraluminal penetrating foreign bodies may remain quiescent for years before presenting a complication, no correlation existed between mortality and the duration of the foreign bodies' retention. The greatest mortality was seen with vascular complications followed by diffuse and local suppurative processes. The overall mortality was significantly reduced in the postantibiotic era.

The Prolonged Presence of a Fish Bone in the Neck

“…Otolaryngologists occasionally find that the use of a flexible laryngeal-fiberscope for discovering bones buried in the mucosa of the pharynx-esophagus relatively difficult, and the consequent delay in diagnosis could result in unnecessary complications. Severe complications are often with vascular, such as aortoesophageal fistula, innominate esophageal fistula, subclavian esophageal fistula and carotid rupture (Remsen et al 1983) and are followed by diffuse or A B Fig. 1.…”

“…local suppurative processes, such as periesophageal abscess, mediastinitis, retropharyngeal abscess, thyroid abscess (Chen and Peng 2011) and deep neck abscess (Tien et al 2007;Chung et al 2008). Although the largest case series to date (a worldwide review of studies from 1818 to 1983; Remsen et al 1983) indicated that penetrating foreign bodies are associated with an overall mortality rate of 45%, most previous deaths have been attributed to their occurrence during the preantibiotic era. Recently, several studies (Loh et al 2000;Athanassiadi et al 2002;Nadir et al 2011) have shown that the major complication rate of foreign bodies in the esophagus was 1.6-7.3%, and that the mortality rate was 0-0.73%.…”

“…These tragic fatal events may be due to the direction and site of migration of the foreign bodies. Remsen et al (1983) reviewed 321 cases of penetrating ingested foreign bodies, and found that 43 (13%) of the foreign bodies had migrated to the extraluminal region. In a more recent study, Chee and Sethi (1999) reported on 24 migrated foreign bodies in the neck, and 18 (75%) of these objects were removed within 24 hours.…”

“…Intraoperative ultrasonography was able to identify the fish bone in situ using real-time imaging; therefore, we recommend this technique for locating migrated foreign bodies in the neck. Ingested fish bones are one of the most frequently observed foreign bodies in the pharynx-esophagus (Remsen et al 1983;Loh et al 2000;Athanassiadi et al 2002); particularly in East Asia, a whole fish is often served without removing its bones. Owing to their fine, linear, and sharp structure, fish bones have a tendency to stick and penetrate the mucosa, which can occasionally lead to severe or lethal complications.…”

Extraluminal hypopharyngeal foreign body

“…A foreign body might also penetrate adjacent visceral structures such as the thyroid gland. Finally, these objects can also penetrate the major blood vessels in the neck and precipitate vascular complications such as aortoesophageal and innominate-esophageal fi stulae and carotid rupture [7].…”