Unusual presentation and management of a penetrating foreign body in the pyriform fossa: a case report

Abstract

Foreign body impaction in the upper aerodigestive tract is considered an emergency that necessitates extraction within 24 hours to prevent adverse events. Rigid oesophagoscopy is crucial in managing sharp, penetrating, and large foreign bodies lodged in the pharynx or at the cricopharyngeus muscle level. In this case report, a 15-year-old male patient presented with throat pain after consuming a chicken meal. He experienced dysphagia and odynophagia but no vomiting, drooling, or hematemesis. Initial video direct laryngoscopy did not reveal any foreign body, and subsequent rigid oesophagoscopy under general anaesthesia was inconclusive. However, a post-operative X-ray of the neck confirmed the presence of a foreign body. A contrast-enhanced computed tomography scan showed the foreign body penetrating the right pyriform fossa. With the assistance of a medical gastroenterologist, a flexible upper gastrointestinal endoscopy was performed, and the foreign body was successfully removed from the right pyriform fossa. Prompt endoscopic removal under conditions of minimal trauma and maximum safety is the preferred treatment approach for foreign bodies in the upper aerodigestive tract, necessitating a multidisciplinary team involving radiologists, otorhinolaryngologists, medical gastroenterologists, and anesthesiologists to develop tailored treatment plans for each patient.