Resident Seoul National University Hospital Seoul, Republic of Korea
Objective: To present a thoroughly planned management of magnetic foreign bodies in the aerodigestive tract with secondary tracheoesophageal fistula. Method: Case report.
Results: A previously healthy 3-year-old girl was referred to our emergency room for having ingested multiple magnets over a week ago. At presentation, the child was seemingly healthy without any signs of respiratory distress, dysphagia or lethargy. Radiologic imaging revealed 3 metallic foreign bodies in the trachea and upper esophagus, with aggregated foreign bodies in the lower-mid abdomen. Emergency suspension laryngoscopy was performed under spontaneous respiration with high flow nasal cannula. The tracheal foreign body was retrieved first considering the risk of foreign body migration once the magnetic interaction is lost between the trachea and esophagus. Using the attraction force between magnets and metallic instruments, an upward forceps was used under endoscopic guidance to successfully detach the tracheal foreign body. At the time of detachment, the instrument was handled in the direction of distal to proximal trachea to prevent distal migration. The remaining metallic beads in the esophagus too were successfully retrieved in the same manner using optical forceps via esophagoscope. A secondary tracheoesophageal fistula was identified but regarding its size and coverage from surrounding granulation tissue, conservative care was done. Upon follow up examination, spontaneous healing appeared successful.
Conclusion: This case presents a challenging yet successful management of foreign bodies simultaneously involving the aerodigestive tract. Many factors were considered during the procedure including anesthetic techniques, sequence of retrieval, handling of adequate instruments, and management of tracheoesophageal fistula.