Chronic Cervical Esophageal Foreign Bodies in Children Surgical Approach After Unsuccessful Endoscopic Management

• Published in: Annals of otology, rhinology & laryngology Vol. 123; no. 1; pp. 19 - 24
• Main Authors: Schramm, Jordan C., Sewell, Ryan K., Azarow, Kenneth S., Raynor, Stephen C., Abdessalam, Shahab F.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.01.2014; SAGE PUBLICATIONS, INC
• Subjects: Age; Child, Preschool; Chronic Disease; Esophageal Stenosis - complications; Esophageal Stenosis - diagnostic imaging; Esophageal Stenosis - surgery; Esophagoscopy; Esophagus; Female; Foreign Bodies - complications; Foreign Bodies - diagnostic imaging; Foreign Bodies - surgery; Hospitals; Humans; Infant; Male; Ostomy; Otorhinolaryngologic Surgical Procedures - methods; Radiography; Retrospective Studies; Tracheoesophageal Fistula - diagnostic imaging; Tracheoesophageal Fistula - etiology; Tracheoesophageal Fistula - surgery; Treatment Failure; Treatment Outcome; chronic illness; preschool child; foreign body; injury; infant; ingestion; neck
• ISSN: 0003-4894; 1943-572X
• DOI: 10.1177/0003489414521145

Objectives: We reviewed the surgical management of chronic cervical esophageal foreign bodies (CCEFBs) in a pediatric population after failed endoscopic retrieval. Methods: A descriptive analysis via a retrospective chart review of patients with CCEFBs who failed initial endoscopic management was performed between 2008 and 2013. Details were recorded regarding presenting symptoms, time from symptom onset to diagnosis of the CCEFB, surgical approach, and complications. Results: Three patients with CCEFBs unsuccessfully managed with endoscopy were identified. The range of ages at diagnosis was 14 months to 4.5 years. The foreign bodies (FBs) were present for at least 1 month before diagnosis (range, 1 to 10 months). Respiratory symptoms were predominant in all cases. Neck exploration with removal of the FB was performed in each case. Complications included esophageal stricture necessitating serial dilations (patient 1), left true vocal fold paresis that resolved spontaneously (patient 3), and tracheoesophageal fistula with successful endoscopic closure (patient 3). No long-term sequelae were experienced. Conclusions: A high index of suspicion is required to recognize CCEFBs in children with respiratory distress. Although endoscopic management remains the first-line treatment, it may fail or may not be possible because of transmural FB migration. In this setting, neck exploration with FB removal is a safe and effective alternative.