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Procedural sedation associated displacement of sharp oesophageal foreign body

Vishal Sondhi1, Suprabha Kumari Patnaik, Atul Khullar

  • 1Pediatrics Department, Military Hospital, Ambala Cantt, India. dr.sondhi@yahoo.co.in

BMJ Case Reports
|May 19, 2012
PubMed

Insights

A child swallowed a sharp board pin, which lodged in the esophagus. Procedural sedation caused muscle relaxation, allowing the pin to move to the stomach, highlighting sedation risks for esophageal foreign bodies.

Area of Science:

  • Pediatric Gastroenterology
  • Emergency Medicine
  • Clinical Case Reports

Background:

  • Esophageal foreign bodies are common in children, requiring interventions like endoscopic removal or observation.
  • Sharp objects pose a significant risk of perforation and complications.

Observation:

  • A case of a child ingesting a sharp board pin lodged at the C(7)-T(1) level for 8 hours.
  • The pin caused tracheal mucosa indentation.
  • Procedural sedation with midazolam and ketamine was administered.

Findings:

  • During sedation, spontaneous muscle relaxation led to the pin migrating to the stomach.
  • Endoscopy revealed minor esophageal mucosal erosions.
  • The foreign body was not retrieved endoscopically but was later spontaneously egested.

Implications:

  • Procedural sedation for aero-digestive tract foreign bodies carries a risk of spontaneous movement due to muscle relaxation.
  • This case underscores the potential for unexpected complications during sedation for esophageal foreign bodies.
  • Careful consideration of sedation's effects on foreign body stability is crucial.

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