How we do it: impacted oesophageal foreign body removal using a dilatation balloon

Background Ingested foreign bodies are a common presentation to paediatric ENT services. Depending on the site, these are usually managed with flexible or rigid oesophagoscopy and retrieval. This paper presents a novel technique for removing a hollow foreign body that could not be removed using conventional means. Method and results After rigid and flexible approaches failed, a guidewire was passed through the foreign body under fluoroscopic guidance and a dilatation balloon passed through the lumen of the object. Inflating the balloon allowed dilatation of the inflamed mucosa above and below the object, facilitating straightforward removal under traction. Conclusion This is a novel and reproducible technique that uses equipment readily available in tertiary referral centres. Employed in this context, the technique enabled removal of an impacted object surrounded by granulation tissue, and would be appropriate for other objects with a lumen.

Ear, Nose, Throat and Head and Neck Surgery Activity in Tertiary Care Center during COVID-19 Pandemic

Introduction: Corona virus disease 2019 (COVID 19) is an infectious respiratory disease caused by the novel virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Till 31st August 2020, 39460 COVID-19 positive cases confirmed and 228 deaths occurred in Nepal. The surgical activities in the division of ENT and HNS (Ear, Nose, Throat and Head and Neck Surgery) across the world has been affected with many hospitals confining themselves to only emergency or essential surgeries due to implementation of lockdown by many countries. Manipal Teaching Hospital being a tertiary care referral centre in western Nepal has wide array of cases coming from various parts of the country and due to the pandemic the surgical activity of our ENT and HNS unit has undergone profound changes. Methods: A six months prospective study of “ENT and HNS Surgical Activity in Tertiary Care Center during COVID-19 Pandemic” was conducted in the department of ENT and HNS, Manipal college of Medical Sciences, Pokhara, Nepal. Statistical analysis of the study was done for various parameters like age, sex, incidence and types of elective and emergency surgeries and comparing the frequency of surgeries done during the COVID-19 pandemic vs that during the same period in the previous year. Results: This study includes a total of 56 surgery cases out of which 26 were emergency and 30 were elective. Among 26 emergency cases, five were ear, one was nose, nine were throat and 11 were head & neck cases. Similarly, among 30 elective cases, six were ear, eight were nose, 11 were throat and five were head & neck cases. The most commonly performed emergency cases were incision and drainage of abscess followed by repair of wounds and rigid oesophagoscopy and removal of foreign body. Commonly performed elective cases were excision of ENT and HNS lesions followed by Functional endoscopic sinus surgery. Conclusions: The COVID-19 pandemic caused a steep decrease in ENT and HNS surgical activities both the elective and emergency surgery.

A piercing story: ingestion of a grill wire brush bristle

Background This paper reports the dangers of an ingested metal wire bristle from a barbeque brush, which resulted in oesophageal perforation. Case report A 49-year-old gentleman presented to the emergency department with foreign body sensation and odynophagia after having consumed barbequed lamb for lunch. Computed tomography of the neck demonstrated a thin linear opacity near the thoracic inlet. The object could not be visualised on emergent rigid oesophagoscopy. Subsequent neck exploration enabled localisation of a retropharyngeal abscess and a thin wire bristle from a barbeque brush. Conclusion Always consider the utensils employed in food preparation as a differential in ingested foreign bodies. Thin wire objects have a high propensity to migrate and result in complications, hence urgent intervention is vital.

Preventing trauma during rigid oesophagoscopy in the edentulous patient: how I do it

BackgroundRigid oesophagoscopy is a widely used therapeutic and diagnostic procedure. Smooth friction-free insertion of the rigid scope is important to prevent oral and oesophageal mucosal damage, as such damage can cause delays in oral intake or more serious complications such as perforation. Protection appliances such as gum guards are useful adjuncts to cushion the teeth in rigid oesophagoscopy; however, there are no specific adjuncts for the edentulous patient.MethodsIn order to investigate different adjuncts, the force required to pull a standard adult rigid oesophagoscope from a metal clamp whilst enclosed in dry gauze, wet gauze, a gum guard or sleek on gauze was recorded, and a prospective audit of post-procedural trauma was performed.Results and conclusionLess force was required to create movement of the scope against sleek on gauze, with a lower rate of oral trauma (8 per cent) compared to that reported in the literature. Sleek on gauze is recommended for the edentulous patient.

A study on radio opaque foreign body in digestive tract of children

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">An estimated 40 percent of foreign body ingestions in children are not witnessed, and in many cases, the child never develops symptoms. Sharp foreign body, button battery must be carefully removed and followed up for any complications. Foreign bodies that have passed the gastroesophageal junction should be assured that the foreign body will probably pass through the GI tract. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">A retrospective analysis of the records of the children below 12 years with foreign body ingestions were analysed and the radio-opaque foreign body were included in the study period between March 2012 to March 2015. The x-ray were analysed, type of foreign body, treatment and complications were noted. </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">There were 45 children included in the study who had ingested foreign body and on radiological evaluation radio opaque foreign body was found. The coin topped the list with 30, button battery- 7 numbers, safety pin- 5 numbers. In 2 children who ingested button battery suffered cricopharyngeal stricture, which was treated with serial dilatation with bougies, while one child with open safety pin ingestion, developed pseudo- aneurysm of arch of aorta and one ear stud developed stridor with sub glottic stenosis. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">The radio opaque foreign though is easy to visualise, but in some case it can dangerous complications. Rigid oesophagoscopy and prompt removal of foreign body is the treatment of choice.</span></p>

An uncommon source for oesophageal foreign body: Fidget spinner

Fidget spinner is a new handheld toy with potential choking and ingestion hazard. Our objectives are to describe clinical presentation of a child with fidget spinner ingestion and draw attention to danger associated with fidget spinner. A 3-year-old boy presented with painful swallowing and feeling of something stuck in the throat. A chest radiograph revealed a radiopaque foreign body with a disc-like component. Rigid oesophagoscopy revealed a foreign object with disc battery and battery holder circuit board. Clinicians should consider the fidget spinner as one of many varieties of toys that has potential for button battery ingestion or aspiration.

Impacted dentures in the oesophagus

Objective:This study presents the incidence of denture impaction in the oesophagus, and discusses the difficulties of managing such cases.Method:A total of 262 patients with a history of foreign body ingestion (between 1999 and 2010) were reviewed; 46 of these patients had dentures impacted in the oesophagus.Results:The cervical section of the oesophagus was the commonest site of impaction. Dysphagia and tracheal tenderness were the most consistent features when dentures became impacted in the upper oesophagus. In most cases, rigid oesophagoscopy enabled successful removal of the impacted denture. Locating an impacted denture hidden within the oesophageal mucosal folds sometimes proved difficult.Conclusion:In cases of impacted dentures in the oesophagus, a positive history helps in the diagnosis, but a high degree of clinical suspicion aids early detection. Conventional radiographs are important but may not always be of assistance. Early intervention reduces complications. Dentures that are poorly maintained and old are more likely to be swallowed accidentally. The inclusion of radiopaque filler within dentures would assist localisation following accidental swallowing.