Foreign body pyriform sinus: an unusual presentation.

Area of Science:

• Otolaryngology
• Medical Imaging
• Surgical Procedures

Background:

• Foreign body ingestion is a common occurrence, particularly in the upper aerodigestive tract.
• The pyriform sinus is a potential site for impaction of sharp foreign bodies, such as fish or chicken bones.
• Accurate localization is crucial for safe and effective removal.

Observation:

• A case of a chicken bone foreign body lodged in the lateral wall of the left pyriform sinus is presented.
• Initial diagnostic imaging, including soft tissue neck X-ray and CT scan, visualized the foreign body.
• Repeated attempts at rigid esophagoscopy failed to identify or retrieve the impacted object.

Findings:

• The foreign body was ultimately detected and successfully removed via lateral pharyngotomy under general anesthesia (GA).
• This case highlights the limitations of standard endoscopic approaches in certain deep-seated or unusually positioned foreign bodies.
• Surgical intervention proved necessary when less invasive methods were unsuccessful.

Implications:

• Lateral pharyngotomy can be a valuable surgical option for removing deeply impacted foreign bodies in the pyriform sinus when endoscopic visualization fails.
• Clinicians should consider a broader differential diagnosis and surgical approaches for persistent foreign body impaction symptoms.
• This case underscores the importance of correlating imaging findings with endoscopic visualization and considering alternative removal techniques.