Flat sticker as a mobile airway foreign body: A case report
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A 2-year-old male had been evaluated at an outside hospital for an approximately 1-hour history of refusal to swallow, mild secretions, and brief episodes of oropharyngeal bleeding. These symptoms began after the patient was noted to be eating a piece of pizza prior to a suspected choking event. On physical exam, the patient was noted to intermittently clutch his chest and throat while coughing. His lungs were noted to be clear to auscultation and his oropharynx did not show any signs of trauma, bleeding, or foreign body. Given that the child was quite stable and without evidence of respiratory distress and no concerning findings on imaging, as well as predominant symptoms of odynophagia and dysphagia, a diagnosis was made of suspected esophageal “foreign body” from impaction of pizza crust.

A plan was formulated to take the patient to the operating room to perform esophagoscopy and removal of esophageal foreign body, as well as possible direct laryngoscopy and bronchoscopy to assess the airway if indicated. A CT chest was performed prior to the surgery to determine if a suspected mediastinal mass was indeed present and would require biopsy at the same time. The CT chest was performed with the patient in the supine position, and revealed a thin, radiopaque, foreign body in the hypopharynx overlying the epiglottis and aryepiglottic folds. The mediastinum was normal in appearance with an age appropriate thymus noted. Given this finding, the decision was made to take the patient to the operating room for direct laryngoscopy, bronchoscopy, and esophagoscopy with removal or airway foreign body.

The patient was bag-masked by the anesthesiology team, upon induction, then given to the otolaryngology to perform direct laryngoscopy and rigid bronchoscopy, and intubation if needed. During direct laryngoscopy, a large (2.5 cm × 2.5 cm) plastic Paw Patrol sticker was noted be lodged in the posterior oropharynx spanning from the posterior nasopharynx to above the epiglottis. As the child inhaled and exhaled, the sticker was observed to intermittently alternate between flipping over the supraglottis in “lid-like” fashion, to being pushed out of the supraglottis and against the posterior hypopharyngeal and oropharyngeal mucosa. Once removed, further examination showed an area of mild erosion and mucous pooling in the right pyriform sinus, which was likely where the sticker had remained lodged for some time. No further swallowing or respiratory issues were noted after the operation, and the patient was discharged on a regular diet the same day.

Source: https://www.sciencedirect.com/science/article/pii/S1930043320304817?dgcid=rss_sd_all
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