Complex Management of a Migrating Inhaled Metallic Foreign Body in a Child: A Multidisciplinary Success

Foreign body (FB) inhalation in children is a common and potentially life-threatening occurrence encountered in pediatric emergency medicine. A wide range of clinical presentations including often delayed onset of symptoms make it challenging to identify and provide a timely diagnosis. This increases the risk of complications and leads to suboptimal outcomes. For instance, inhalation of sharp objects may lead to perforations and migrations to surrounding structures making it difficult to retrieve the FB as seen in this case. Additionally, the onset of symptoms can vary, making it difficult to diagnose based on a patient's history alone. An unusual case of an inhaled sharp metallic object (dental bur) in a 13-year-old boy that migrated from the left lower thorax to the right perihilar and finally to the gastric lumen is presented a week after the incident. A 13-year-old boy presented to the emergency department with mild symptoms. He was stable with normal chest findings. Previous rigid bronchoscopy failed to localize and remove the FB and the thoracotomy. A post-operative X-ray was done, and the migration of the FB to the right middle lobe was revealed. A flexible bronchoscopy was then performed, again with no positive results. It was finally the abdominopelvic CT scan followed by the gastroduodenal esophagoscopy that allowed us to visualize and remove the FB from the gastric lumen.  In this case, we review the literature to emphasize the diagnostic challenges of FB inhalation in children, focusing on key diagnostic clues that assist clinicians in managing this condition.