MANAGEMENT OF FOREIGN BODY

‘EARRING’ WITH ESOPHAGOSCOPY

IN A 7 MONTHS OLD BOY
Elvien Dwi Saleh, Linda I. Adenin
INTRODUCTION
￮ Children less than 5 years of age routinely explore their environment by placing
objects in their mouths. As such, they are at a significantly increased risk for both
the accidental ingestion of harmful substances and foreign bodies becoming
lodged within the aerodigestive tract. These events are potentially life threatening.
As such, it is necessary for all Otolaryngologists to be familiar with the diagnosis
and management of these conditions (Cole, Kearns dan Magit, 2011; Yunkerdan
Friedman, 2014).

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A variety of foreign bodies impacting in esophagus
are ingested by children and mentally deranged
patients with the most common being coins. The
size and shape of foreign body will dictate where it
lodges but common sites areas of constriction at
the cricopharyngeus, at the level of the aortic arch
and at the cardia (Chevretton, 2008; Schramm et al,
2014).

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 Emergent removal of the foreign body should be performed
in symptomatic patients unable to swallow their own

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secretions or who are experiencing acute respiratory
symptoms. Howeverin these situations the risk of aspiration
of gastric contents is higher and appropriate precautions
should be taken. In patient who are asymptomatic,
endoscopy can be postponed for 12 to 24 hours. There are
two important exceptions to this principle.
The first is if the foreign object appears to be a disc battery.
The second is if the foreign object is sharp and/ or has the
potential to perforate the esophagus, such as an open
safety pin. In these situations, emergency endoscopy is
required. If there is a significant delay between the time of
diagnosis and endoscopy, a repeat radiograph should be
obtained immediately prior to the procedure to verify that
the object has not passed into the stomach..

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 CASE
CR REPORT
PATIENT
￮ A patient, 7 months old boy refered
from Langsa General Hospital to Adam
Malik General Hospital June 25rd 2017
And some text
￮ main complaint patients cry when
trying to drink breast milk and vomiting
when finished drinking
Radiograph also showed radioopaque
foreign body.

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he accidentally consumed earring 6 hours before coming to
hospital while he was playing

There was history of vomit 10 minutes after he accidentally

consumed the earring. There are no history of coughing, choking,
dispone, retraction , stridor, cyanosis.

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The physical
examination

we found no abnormality in oropharyng and

laryng. The rontgen from June 25rd 2017
showed there was foreign body metal at the
projection as high as vertebra cervicalis 5-
7.We diagnosed the patient with foreign body
on the esophagus and planned
esophagoscopy for this patient. 8
planned esophagoscopy for this
patient

The patient The patient The result of chest

underwent was fasting x-ray on June 25rd
some for 8 hours 2017 showed there
was foreign body
examination e.g before this metal at the
blood laboratory procedure. projection as high
test and repeat as vertebra
the chest x ray cervicalis 5-7 and
before the the then he was
esophagoscopy. brought to the
operating theatre.

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 The operation was done on June
25rd 2017 in Adam Malik General
Hospital Operating Theater
￮ Patient was anasthesized with ETT and IVFD well attached,
￮ Then the operation area was desinfected using bethadine and
alcohol 70%,
￮ The area around the operated area was covered with sterile doek.
￮ Patient on supine position with shoulder in the edge of the table the
insert the esophagoscope carefully in vertical position through the
oropharyng. Simultaneously we slowly lifted his head and we can
evaluate valecula, epiglottic, pharyngo-epiglottica plica and laryng.
￮ We entered the right pyriform sinus by inserting esophagoscope
through right side of tongue until posterior pharyngeal wall. When
we entered the pyriform sinus we found the lumen was unseen
because the cricopharyngeal muscle always contracted expect for
swallowing.
￮ When passing through the cricopharyngeal, We saw the metal
yellow goldish metal in cricopharyngeal area and inserted the
forcep into the esophagoscope and clipped the earring thightly,
then pulled out simultaneously the esophagoscope and the forcep.
The earring pulled out succesfully and we evaluate the esophagus to
reassure there were not any laceration or abnormality.
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￮ Post operation, we inserted nasogastric tube and evaluate for 2
days.
FOREIGN Place your screenshot here

‘EARRING’.
BODY

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After the surgery

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After the surgery the patient was given antibiotic,
analgetic and diet via nasogastric tube for two days.
On third day we took off the nasogastric tube and he
went home.

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 DISCUSSION

Children less than 5 years of age routinely

explore their environment by placing objects in
their mouths.

In this case our patient was 7 months and the foreign

body accidentally ingested and lodged in esophagus
tract

Patients cry when trying to drink breast milk and

vomiting when finished drinking. Radiograph also
showed radio-opaque foreign body.

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 DISCUSSION

In the Unites States and Europe, coins are the

mostcommonly ingested pediatric foreign body.
Other commonly ingested items include toy parts,
sharp object, batteries, fish bones, and food.
Approximately 60% to 70% become lodged at the
upper esophageal sphincter or cricopharyngeus
muscle, 10% to 20% impact in the midesophagust
the level of the aortic notch, and 20% are held up by
the lower esophageal sphincter

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 DISCUSSION

In this case the patient ingested earring and lodged

at upper esophageal sphincter or cricopharyngeus
muscle which was the most common lodged area.

Evaluation of patients with a suspected esophageal

foreign body should include both anteroposterior and
lateral x-rays to verify that the object is indeed in the
esophagus rather than in the airway

For this patient we performed anteroposterior and

lateral x-rays and found the foreign body was in
esophagus area.

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 DISCUSSION
Endoscopy under general anesthesia with a
protected airwayis the mainstay of
esophageal foreign body management with
esophagoscopy is not without risk, including
pharyngeal bleeding, accidental extubation,
hypoxia, esophageal perforation, and
mediastinitis
The procedure performed in general
anesthesia and there weren’t any
complication post operation.

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 CONCLUSION

￮ We report a case of foreign body ‘earring’ and performed esophagoscopyand the

outcome was satisfying.

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Thanks!
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