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OC28 My heart is in my throat: a delayed presentation of oesophageal foreign body (FB)
  1. Muhammad Abu Bakar1,
  2. Lucy Howarth1,
  3. Oliver Brain1,
  4. Merrill McHoney1,
  5. Asad Nasim2
  1. 1Oxford University Hospital NHS Foundation Trust
  2. 2Wexham Park Hospital, Slough, UK

Abstract

Introduction Oesophageal Foreign body (OFB) ingestion, a common and serious problem in children, can present with a wide variety of symptoms. This paper describes and discusses the rare case of delayed presentation of an oesophageal foreign body, initially presenting as severe nose bleed after trauma.

Presentation of Case A 7-year-old girl presented with a three-day history of intermittent severe upper gastrointestinal bleed following minor nose trauma. She had multiple episodes of haemetamesis and vasovagal syncope. She had a background history of oral feeding aversion leading to faltering growth from a very young age but no obvious cause was found. She was pale, tachycardic and her haemoglobin dropped from 80 g/l to 49 g/dl. She was transfused, and a CT head was reported as normal, with no fractures identified. Because of the nasal trauma, anterior rhinoscopy and flexible nasendosopy (FNE) was performed by ENT, with no source of bleeding identified. Oesophago-gastrodudenoscopy (OGD) showed an ulcer at 15 cm from the incisors, and a 2 cm wide plastic heart shaped foreign body embedded in the base of the ulcer. It was associated with post-infammatory polyps covering half the circumference of the oesophagus. The foreign body was removed successfully and there was no further bleeding noted after foreign body removal. Chest X ray performed following procedure demonstrated a pneumomediastinum which was later confirmed on CT chest. She was kept nil by mouth and had a insertion of gastrotomy for feeds. Repeat contrast studies were performed in the convalescent period to confirm healing of the presumed oesophageal leak. Four months post-surgery a contrast study demonstrated no leak and no further oesophageal abnormality noted. She was restarted on feeds, and tolerated this with no clinical concern, and is now asymptomatic and well.

Discussion Ingestion of FB is a common problem in young children. The majority of OFBs pass harmlessly through the gastrointestinal tract; however, some OFBs can cause significant morbidities. The diagnosis may be delayed leading to several complications especially if the ingestion of the FB is unwitnessed and when the clinician does not think of FB ingestion as part of the differential diagnosis of oral food aversion.

Conclusion It was a case of long standing oesophageal foreign body (EFB) which unusually presented with a life threatening upper gastrointestinal bleed. This case highlights the importance of considering FB ingestion in a child with background history of ongoing feeding difficulties

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