International Journal of Contemporary Pediatrics
Chhabra GS et al. Int J Contemp Pediatr. 2021 Feb;8(2):383-385
http://www.ijpediatrics.com pISSN 2349-3283 | eISSN 2349-3291
DOI: https://dx.doi.org/10.18203/2349-3291.ijcp20210135
Case Report
Chronic retained esophageal foreign body: a case report
Gurpreet Singh Chhabra1, Anumeet Singh Grover2*, Gagandeep Kaur1
1
Department of Pediatrics, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India
2
Department of Gastroenterology, KEM Hospital, Mumbai, Maharashtra, India
Received: 01 December 2020
Revised: 12 January 2021
Accepted: 13 January 2021
*Correspondence:
Dr. Anumeet Singh Grover,
E-mail: gagan2904@gmail.com
Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
Chronic esophageal foreign bodies (CEFB) are associated with a high incidence of morbidity and mortality in adults.
However, the presentation, management and outcome of chronic esophageal foreign bodies in children are not well
described. Seventy-six percent of patients presented with a primary complaint of respiratory symptoms, with
respiratory distress being the most common followed by asthmatic symptoms and cough. Twenty-two percent of
patients had primarily gastrointestinal symptoms including nausea, vomiting and dysphagia. We present a case report
of 2year 6month old male with 3 months history of cough and vomiting later diagnosed to be a case of upper
esophageal foreign body impaction.
Keywords: Cough, Foreign body, Esophagus, Endoscopy
INTRODUCTION 48 h before admission, he had repeated attacks of cough,
vomiting and dysphagia. There was no history of fever,
The natural tendency of children to explore their weight loss and drooling of saliva. On examination, he
environment orally makes the ingestion of FBs common, had a temperature of 38.5 °C and oxygen saturations of
especially in those less than six years old. Most of the 95% in air. Respiratory rate was of 30/minute and heart
times children find small things attractive and prefer rate of 136/minute.
mouthing those objects. Recurrent upper respiratory tract
infections secondary to esophageal foreign body
ingestion is a lesser common occurrence. Most of the
times such cases go undiagnosed due to child being non-
compliant. The diagnosis can be missed or delayed when
the presenting symptoms are mainly respiratory. This
work has been reported in line with the SCARE criteria.1
CASE REPORT
A 2 year 6 month-old male came to OPD with complains
of cough, vomiting and regurgitation of solids. He had a
three months history of recurrent bouts of cough and
congestion. There was no history of ingestion of foreign
body witnessed by the parents. He was treated on
multiple occasions with corticosteroid and antibiotics. Figure 1: Barium meal images.
However, cough got progressively worse. During the last
International Journal of Contemporary Pediatrics | February 2021 | Vol 8 | Issue 2 Page 383
Chhabra GS et al. Int J Contemp Pediatr. 2021 Feb;8(2):383-385
On ausculatation crepitations and diffuse wheeze was retained in the esophagus more than one week is rare. It
present. Cardiovascular examination was normal. Blood presents differently, and the respiratory symptoms are
tests showed a microcytic hypochromic anaemia and more common than gastrointestinal symptoms.3
eosinophilia with AEC of 1100cells/cumm. C-reactive
protein and chest- X-ray was normal. The child was Clinicians should keep in mind that an esophageal FB can
managed with intravenous cefotaxim 100 mg/kg/day, lead to atypical symptoms that simulate asthma, croup,
nebulised with salbutamol and budesol. The improvement bronchitis, or bronchopneumonia. Our patient had
was slow and partial. ENT call was done and endoscopy persistent cough and wheeze which failed to respond to
advised. Barium swallow was done which suggested asthma treatment.
constriction of upper esophagus with proximal hold up of
oral contrast. (Figure 1). Most commonly described esophageal FBs are coins, and
other ingested objects include toy parts, jewels, batteries,
needles, pins, balls, and buttons.4,5 The majority of FB
ingestions occur in the pediatric population, with a peak
incidence between six months and six years of age.6,7 The
majority of impacted FB is found just underneath the
cricopharyngeal muscle because of the weak peristalsis in
that region. The rest are found in the physiological
narrowing of the esophagus at the level of the aortic arch,
the left main stem bronchus and the lower esophageal
sphincter.8,9 The degree of damage depends on the nature
of the impacted EFB, duration, pre-existing
esophageal/tracheal pathology, site of impaction and the
age of the child.10 The management of esophageal foreign
bodies is removal by means of a rigid or flexible
endoscope wherever possible. When endoscopic retrieval
Figure 2: Endoscopy images. is not possible, immediate open surgical extraction should
be performed.11
CONCLUSION
The facts that the accident of ingestion was not
witnessed, and the child did not improve by medications.
Also, foreign body was covered by granulation tissue
hence not identifiable during endoscopy made the
diagnosis difficult. In conclusion, persistent cough with
wheeze with no obvious cause should arouse the
suspicion of the esophageal foreign body in children.
Funding: No funding sources
Conflict of interest: None declared
Ethical approval: Not required
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Figure 3: Object retrived after endoscopic removal.
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