Infant swallows Heart of Gold- a case report

Dr Shelby Leuin, at the University of California, San Diego, School of Medicine, San Diego, CA and colleagues have reported a rare case of foreign body oesophagus in shape of Heart of Gold. The case has appeared in the NEJM.

Food and a variety of other swallowed objects can become impacted in the oesophagus. Oesophagal foreign bodies cause dysphagia and sometimes lead to perforation. Diagnosis is clinical, but imaging studies and endoscopy may be needed. Some objects pass spontaneously, but endoscopic removal is often required.

Infants and toddlers do not have fully mature oropharyngeal coordination and often inadvertently swallow small, round foods (eg, grapes, peanuts, candies), which may become impacted. In addition, infants and toddlers often swallow a wide variety of inedible objects (eg, coins, batteries), some of which become impacted in the oesophagus. Impacted disc batteries are particularly worrisome because they may cause oesophagal burns, perforation, or tracheoesophageal fistula.

According to history, a 3-year-old girl presented to the emergency department after she had ingested a metal pendant. She had not vomited and had no pain in her chest. A physical examination was unremarkable. A radiograph of the chest confirmed a heart-shaped foreign body in the proximal thoracic oesophagus. Ingestions of foreign bodies are most commonly reported in children 1 to 3 years of age.

Courtesy NEJM

Ingested items that warrant immediate endoscopic removal from the oesophagus include sharp objects, button batteries, and foreign bodies that have been present for longer than 24 hours. Asymptomatic children who have ingested items that do not have potentially dangerous features may be observed without intervention to allow the foreign body to pass spontaneously.

In this patient, the position of the foreign body appeared to be unchanged on repeat radiographs of the chest. The patient was taken to the operating room to undergo rigid endoscopy, and a gold heart-shaped pendant was removed (inset). Reinspection of the oesophagus showed minor abrasions of the oesophagal mucosa. After the procedure, the patient recovered well and was discharged home.

For more details click on the link: DOI: 10.1056/NEJMicm1716103