|Year : 2019 | Volume
| Issue : 2 | Page : 106-109
Unusual foreign bodies in the aerodigestive tract
Aluko AA1, Ajiya A1, Tukur AR2
1 Department of Otorhinolaryngology, Aminu Kano Teaching Hospital/Bayero University, Kano, Nigeria
2 Department of Otorhinolaryngology, Aminu Kano Teaching Hospital, Kano, Nigeria
|Date of Web Publication||04-Nov-2019|
Dr. Ajiya A
Department of Otorhinolaryngology, Aminu Kano Teaching Hospital/Bayero University, Kano
Background Foreign body impaction in the airways is usually accidental in adults and deliberate insertion is rare. Magicians and other traditional healers perform various forms of magic, which are dangerous and could sometimes fail. This report conveys our recent experience with the aspiration of needles by magicians following failed magic.
Case Summary Two male magicians aged 19 and 24years presented with the aspiration of 2 needles each while performing magic to sell their traditional medicines. Both had similar symptoms of dysphagia, odynophagia and neck pain. Plain radiograph of the soft tissue neck confirmed long sewing needles in the Pharynx and larynx respectively. Both patients had their foreign bodies successfully removed under general anaesthesia.
Conclusion Dangerous forms of magic could fail and may lead to life-threatening emergencies. Fatal outcomes are only avoided if facilities and expertise are readily available.
Keywords: Needles, magicians, adults, aspiration
|How to cite this article:|
AA A, Ajiya, AR T. Unusual foreign bodies in the aerodigestive tract. Sub-Saharan Afr J Med 2019;6:106-9
| Introduction|| |
Swallowed and inhaled foreign bodies are a common problem and considered serious causes of morbidity and mortality. Foreign body impaction in the aerodigestive tract is usually accidental in adults , however, deliberate insertion do rarely occur. Magicians and other traditional healers perform various forms of magic art, which are dangerous and could sometimes fail resulting in some complications. Commonly, foreign bodies in the aerodigestive tract present with dysphagia, difficulty with breathing, stridor or change in voice depending on where the foreign body is impacted. These are case reports of two magicians who presented to our clinic on different occasions with accidental impaction of foreign bodies in their aerodigestive tract while performing magic in which one presented with doubly impacted radio-opaque objects in the larynx. We aim to highlight the challenges in the management of such patients.
| Case i|| |
A 19-year old male magician presented with a 10-hour history of aspiration of a sewing needle while performing magic to sell his traditional medicines. He was presented with symptoms of dysphagia, odynophagia and neck pain. Examination findings revealed a young man, anxious, and in painful distress, pulse rate was 106 beats per minute, with a blood pressure of 150/75mmHg, axillary temperature of 37.2°C and oxygen saturation of 95% in room air. There was drooling of bloodstained saliva.
On throat examination, the foreign body was visualized impacted in the oropharynx along the posterior pharyngeal wall from the nasopharynx down into the hypopharynx. Plain radiograph of the soft tissue neck confirmed a long sewing needle in the pharynx ([Figure 1] and [Figure 2]).
|Figure 1 X-ray soft tissue neck-lateral view for case I showing a radiopaque foreign body|
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Patient was admitted into the ward, baseline investigations (FBC+ differential, E/U/Cr, Urinalysis) were within normal limit. He subsequently had a successful pharyngoscopy and foreign body removal under general anaesthesia. He was put on intravenous 5% dextrose saline 1 litre 8 hourly for 24 hours, intravenous amoxycilline-clavulanic acid 600 mg 12 hourly for 24 hours and intravenous paracetamol 600 mg 8 hourly for 24 hours. He was observed for 24 hours and discharged after counseling.
| Case ii|| |
A 24-year old male was presented at the ear, nose and throat department of Aminu Kano Teaching Hospital, Kano, Nigeria with painful swallowing of two days duration following accidental ingestion of needles he was playing with while performing magical art. On examination, patient was in painful but not in respiratory distress with mild tenderness over the central anterior neck.
A lateral ([Figure 3]) and anteroposterior ([Figure 4]) radiographic views of the soft tissue of the neck revealed two doubly impacted radio-opaque foreign objects crossing each other in the laryngeal airway, extending from the third to fifth cervical vertebra. The anterior ends were pointing downwards and anteriorly buried within the crico-tracheal tissue, while the posterior ends were pointing upwards.
|Figure 3 X-ray soft tissue neck-lateral view for case II showing two radiopaque foreign bodies in the airway|
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|Figure 4 X-ray soft tissue neck- anteroposterior view for case II showing the 2 radiopaque foreign bodies|
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The patient had rigid endoscopy and removal of foreign body under general anesthesia. Intra-operatively, the heads of the needles were sighted as rusted, black objects at the right pyriform fossa. Using an appropriate foreign body grasping forceps, the needles were individually disimpacted and removed gently in one piece with no mucosa incision. Further examination did not reveal additional injuries. He was placed on intravenous ceftriaxone 1 g for 24 hours, intramuscular diclofenac 75 mg 12 hourly for 24 hours and intravenous hydrocortisone 100 mg 6 hourly for 24 hours. Medications were converted to oral after 24 hours. The post-operative period was unremarkable. He was counseled and discharged after 48 hours on admission. However, patient did not turn up for follow-up review.
| Discussion|| |
Unusual foreign bodies in the aero-digestive tract pose challenges in diagnosis and especially treatment. In the first case, patient had endotracheal intubation, the upper end of the foreign body was located and foreign body gently disimpacted and removed. However, the second case posed challenges to both the anesthetic and the surgical teams. Patient could not be intubated due to the position of the foreign bodies and thus intermittent apneic technique was adopted. Identifying the foreign bodies was difficult and took sometime, however, careful examination later revealed them. Finally, disimpacting and removing the foreign bodies without causing additional injuries required gentle and slow manipulations.
Foreign bodies in aerodigestive tract are widely documented especially in the paediatric age group , however, foreign body aspiration as an occupational hazard in magicians is unusual and rarely occur. Unusual foreign bodies in adults are commonly seen in those who are depressed, psychologically disturbed, seeking attention or in jugglers or magicians where they swallow objects during their performance.,,,, Magicians do fail in their magic and have an unusual foreign body impacted along their aerodigestive tract.,,, Nimkur et al. reported a 25-year old magician with pharyngeal intramural foreign body.
Ahmad et al. in Maiduguri reported up to 3.8% in his series to be magicians with impacted needles. This shows that these unusual foreign bodies are not commonly encountered in otorhinolaryngology practice and thus the importance of careful evaluation as revealed in our reports. Singh et al. in India reported an unusual impaction of sewing needle in the nasopharynx of an adult following sneezing.
It has been observed that majority of the incidents of unusual foreign bodies among magicians involved young magicians (less than 30years),,, this could be due to their naivety and poor understanding of the magical processes they saw their older ones pretend to be doing. However, Salisu et al. reported a 32-year old magician with impacted sewing needle in the larynx. Unusual aerodigestive tract foreign bodies either accidentally or deliberately ingested could pose a significant risk for morbidity and occasionally mortality. These types of foreign bodies and their locations pose dangers of perforations with possibility of mediastinitis and its attendant morbidity and/or mortality. If impacted in the laryngotracheal airway also pose risk of oedema and upper airway obstruction. Therefore prompt and skilled intervention should be the watchword.
| Conclusion|| |
Unusual foreign bodies are rarely found among adults of whom magicians are at risk group. Dangerous forms of magic could fail and may lead to life-threatening emergencies. Fatal outcomes are only avoided if facilities and expertise are readily available.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]