| A 74 year
old patient with a past history of hypertension
and laryngectomy complete with laryngostomy from
a malignant neoplasia of the larynx, who was referred
to the emergency department after four days of
pharyngeal pain that increased on swallowing,
without sialorrhoea or dysphagia with solids or
liquid, after having received treatment with paracetamol
by his primary medical practitioner without clinical
improvement. As to the cause of this picture,
the patient referred to eating rice with clams
indicating the possibility of accidental ingestion
of a valve of the reported mollusk.
Exploration of the oral cavity using tongue depressor
as well as indirect laryngoscopy with laryngeal
mirror and topical lidocaine showed no foreign
body. A soft tissue neck x-ray was carried out
and revealed an object in the anterior hypopharynx
compatible with the calcareous seashell of mollusk.
Finally the foreign body was extracted using
gastroscopy with mild sedation, without any subsequent
complications and so the patient was discharged.
Foreign bodies in the pharynx are more common
in adults than in children. Amongst the variety
that can be expected, the more frequently treated
are fish bones that have been inadvertently swallowed
and stuck in the base of the tongue and in the
tonsils.
The presentation itself is very suggestive, consisting
of pharyngeal pain and in the case of acute obstruction
of the digestive tract: sialorrhoea and complete
dysphagia with solids and liquids. Among the range
of investigations that may be done, including
a thorough exploration of the oropharynx, indirect
laryngoscopy, lateral soft tissue neck x-ray,
oesophagoscopy and endoscopy, the last method
is best alternative for both therapeutic and diagnostic
management of this case.
Authors:
Víctor Abadía Gallego
Residente 2º Año Medicina Familiar y Comunitaria
Unidad Docente de Zaragoza
Clara Aznar Gracia
Sección de Endoscopia Digestivas
Hospital Clínico Universitario “-
Lozano Blesa” Zaragoza
Translation: Kelly
Watt |
