Publications
Multiple Atypical Esophageal Foreign Bodies in an Infant
Attibele Mahadevaiah Shubha, Roma Varik , Kanishka Das Foreign body ingestion is a common accidental emergency in children. We report an unusual case of multiple blunt and sharp esophageal foreign bodies in a female infant probably associated with homicidal intent and its management. Accidental ingestion of a foreign body (FB) is a common pediatric emergency. Males aged <5 years are at greater relative risk. Nearly 40% of FB ingestions in children are unwitnessed, of which up to half remain asymptomatic. Coins are the most frequently ingested FB, but a diverse variety of household items are documented. Although 80%–90% pass through the gastrointestinal tract spontaneously, 10%–20% need endoscopic or surgical removal.[1] FB ingestion in neonates and infants is anecdotal and usually accidental[2] but occasionally linked to child abuse.[3] We detail the presentation and management of a female infant with multiple esophageal FBs due to a suspect homicidal intent. A 4-month-old female was brought with cough, excessive salivary drooling, and vomiting of feeds for a week. Her father had succumbed to injuries after a motor vehicular accident 10 days prior. The infant was brought and cared for by the grandmother. She was referred to our center with a chest X-ray showing “many open safety pins and a coin” in the cervicothoracic region. Even after repeated interrogation, there was no history of FB ingestion; both the mother and accompanying kin denied knowledge of any foul play.
Barring excessive salivation, the physical examination was unremarkable. The chest skiagram showed four open safety pins and one mid-thoracic coin. Three of the safety pins were at the mid-thoracic level and one in the cervical region. Although only one safety head was delineated on the skiagram, all the safety pins seemed to be open with the sharp-pointed ends directed cranially [Figure 1]. At rigid endoscopy (Karl Storz bronchoscope sheath, No. 10338D; 0° telescope, No. 27018AA), the mucosa at the sites of impaction was inflamed. Four open safety pins were encountered at the corresponding levels. Two open safety pins did not have the safety heads, and the pointed tips were directed cranially, all partially rusted. A continuous hemorrhagic ooze from the inflamed mucosa compromised visibility at endoscopy. The pointed ends of three pins were carefully grasped by the optical forceps (Karl Storz, Peanut grasping forceps, No. 10378) and partly drawn into the endoscope sheath during retrieval to prevent further injury. Endoscopic retrieval was aided by intraoperative fluoroscopy. In addition, three 2.5-cm diameter coins were also retrieved. The fourth pin slipped into the stomach and was removed at laparotomy/gastrotomy [Figure 2] as it was not visualized with the rigid scope and a flexible one was not available.
