Migratory Foreign Bodies in the Aerodigestive Tract: The Importance of CT Imaging

Accidental ingestion of foreign bodies forms a major part of otorhinolaryngological emergencies. It is dangerous, as the foreign bodies tend to perforate the aerodigestive tract. Since endoscopy is diagnostic as well as therapeutic, it is preferred over computed tomography (CT) scan, especially in developing countries. We present a case of a middle-aged man who presented with fever, neck swelling, and a five-day history of accidental ingestion of a foreign body. He underwent upper gastrointestinal endoscopy, which came out as normal. CT) imaging was performed, which showed migration of the foreign body to the parapharyngeal space and resulting abscess formation. The abscess was drained, and the foreign body was removed transcervically. We discuss this case to stress the role of CT imaging in the diagnosis of foreign bodies of the upper aerodigestive tract and propose an algorithm for the management of such cases. Upper gastrointestinal endoscopy alone would be insufficient to diagnose perforating and migrating foreign bodies, which may cause severe complications if left undiagnosed.