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A prickly situation: an attempted Caterpillar ingestion - case report
Amar K Bhardwaj1, Naif Fnais2,3, Christopher J Chin4,5,6
1Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada.
Insights
A novel technique using medical tape effectively removed irritating caterpillar setae from a child's mouth. This fast, safe, and efficient method offers a new solution for managing foreign body ingestion in pediatric patients.
Area of Science:
- Pediatric Emergency Medicine
- Toxicology
- Otolaryngology
Background:
- Foreign body ingestion is a frequent pediatric concern.
- Spotted Tussock Moth (Lophocampa maculata) caterpillars present unique removal challenges due to their setae.
- This case highlights the management of an 18-month-old child with ingested caterpillar setae.
Observation:
- The child presented with secretions and odynophagia after oral contact with a caterpillar.
- Examination revealed numerous fine setae embedded in the lips and tongue.
- Direct laryngoscopy confirmed setae were confined to the anterior oral cavity, with no airway involvement.
Findings:
- Traditional forceps removal of setae was difficult and time-consuming.
- A new technique involving drying the mucosa with gauze and applying waterproof medical tape proved highly effective.
- This method rapidly removed the majority of the caterpillar setae.
Implications:
- This study introduces a novel, efficient, and safe method for removing caterpillar setae from the oral mucosa.
- The described technique offers a valuable addition to the pediatric foreign body removal toolkit.
- This approach may reduce procedural time and improve patient outcomes in similar cases.
Background:
Foreign body ingestion is a common problem in pediatrics. Each foreign body can present its' own unique challenges during removal, and we present the management of an ingested Spotted Tussock Moth (Lophocampa maculata), more commonly known as a caterpillar.
Case Presentation:
An 18-month-old boy presented to the emergency department with difficulty handling secretions and odynophagia. It was reported he had placed a caterpillar in his mouth and then spat it out. On examination, hundreds of miniscule filaments (setae) were seen embedded in his lips and tongue. Our service was consulted out of concern for airway involvement. The patient was taken to the operating room where a direct laryngoscopy under general anesthesia with spontaneous ventilation was performed to confirm the setae were confined to the anterior tongue and lips. Once we were satisfied the airway was stable, the airway was secured, and we then began to remove the setae. The initial method used was to use Adson-Brown forceps to remove the setae, however this proved difficult and time-consuming given the volume of setae and how thin the setae were. Ultimately, a more effective technique was developed: a 4 × 4 AMD-RITMES® gauze was applied to the mucosa in order to dry up any secretions and then a piece of pink, waterproof BSN medical® tape was applied to the mucosa. After 3 s of contact it was removed. This technique was then repeated and was used to remove the vast majority of the setae.
Conclusion:
To our knowledge, we have described the first technique to remove the caterpillar setae from the oral cavity mucosa in a fast, safe and efficient manner.
