A prickly situation: an attempted Caterpillar ingestion - Ca
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An 18-month-old boy presented with difficulty handling secretions and odynophagia. It was reported by his parents he had placed a caterpillar in his mouth and then spat it out. The caterpillar was identified as a Lophocampa maculata (Spotted tussock moth) by visual comparison to other referenced images by the parents. On examination, hundreds of miniscule filaments (setae) were seen embedded in his lips and tongue. The patient was assessed in the Emergency department.

Upon initial assessment, the patient was drooling significantly but there was no stridor or dysphonia heard. The anterior tongue, buccal mucosa and lips were coated in setae. It was decided the patient should be examined in the operating room to rule out laryngeal/hypopharyngeal involvement, and to remove the setae. The patient was taken to the operating room. After induction of general anaesthesia with spontaneous ventilation, direct laryngoscopy was performed to assess the upper airway and oropharynx. There was no evidence of setae in the oropharynx or larynx and it was confirmed the setae were confined to the anterior tongue and lips, with no evidence of upper airway edema.

At this point, doctors began the removal of the setae from the patient’s lip, tongue and buccal mucosa. The initial method used was to use Adson-Brown forceps to remove the setae, however this proved difficult and time-consuming given the large volume and how fine the setae were. Ultimately, a more effective technique was developed: a 4 × 4 AMD-RITMES® gauze was applied to the mucosa in order to dry up any secretions and then a piece of pink, adhesive waterproof BSN medical® tape was applied to the mucosa. After approximately 3s of contact, the tape was removed. This technique was then repeated and was used to remove the majority of the setae.

It should be noted that not all small filaments were removed, with a few left embedded in the mucosa and within the tongue papillae, as these were quite difficult to extract. The patient was then reversed from general anesthesia, extubated and transferred to the post-anesthesia care unit in stable condition. The child was admitted overnight to observe for any potential complications such as delayed systemic toxicity. The patient was discharged the following day with no further issues.

Source: https://journalotohns.biomedcentral.com/articles/10.1186/s40463-020-00470-1
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