Hypopharyngeal Esophageal Foreign Bodies Removed through Cervical Incision

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  • Nakamura Kazuhiro
    Department of Otorhinolaryngology Head and Neck Surgery, Tokyo Medical University Hachioji Medical Center
  • Yoshida Tomoyuki
    Department of Otorhinolaryngology Head and Neck Surgery, Tokyo Medical University Hachioji Medical Center
  • Suzuki Nobuhiro
    Department of Otorhinolaryngology Head and Neck Surgery, Tokyo Medical University Hachioji Medical Center
  • Takenouchi Tsuyoshi
    Department of Otorhinolaryngology Head and Neck Surgery, Tokyo Medical University Hachioji Medical Center
  • Okamoto Isaku
    Department of Otorhinolaryngology Head and Neck Surgery, Tokyo Medical University Hachioji Medical Center
  • Tokashiki Ryoji
    Department of Otorhinolaryngology, Tokyo Medical University
  • Suzuki Mamoru
    Department of Otorhinolaryngology, Tokyo Medical University

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Other Title
  • 頸部外切開にて摘出した下咽頭食道異物症例の検討
  • 症例報告 頸部外切開にて摘出した下咽頭食道異物症例の検討
  • ショウレイ ホウコク ケイブ ガイ セッカイ ニテ テキシュツ シタ カ イントウ ショクドウ イブツ ショウレイ ノ ケントウ

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Abstract

Introduction Foreign bodies caught in the pharynx or esophagus are relatively common occurrence encountered in ambulatory practice. These can normally be extracted orally or endoscopically, but for some types of foreign bodies an external incision is required. We encountered 3 patients with hypopharyngeal esophageal foreign bodies that required external incisions for extraction. The details are given below.<br>Cases Cases 1 and 2 reported a loss of their dentures, which were recognized in the hypopharyngeal esophagus imaged by CT and plain X-ray. Both were removed within a day via an excision of the neck under general anesthesia.<br>Case 3 was brought to our emergency department with a major complaint of facial and neck swelling that suddenly developed during a meal. CT revealed subcutaneous cervical emphysema, mediastinal emphysema and a foreign body in the hypopharyngeal esophagus. Emergency care was considered to be primary importance, but the patient consulted us only on the 11th day. An emergency incision was made in the neck. The mucous membrane of the cervical esophagus was found to be necrotic, and a crab shell was located outside the esophagus. On the 78th day after onset, the patient succumbed to septicemia.Discussion Because the mucous membrane of the hypopharyngeal esophagus is thin and can readily be punctured by a sharp object, detailed information must be obtained about the swallowed object. If the clasp of a removable denture is accidentally lodged in the esophageal wall, improper removal may result in perforation of the esophagus. Case 3 illustrates the unfortunate consequences of a delayed operation.Conclusion With hypopharyngeal esophageal foreign bodies, a prompt diagnosis is of primary importance and delayed treatment proves to be fatal. Detailed history taking, prompt diagnosis, and appropriate treatment are essential.

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