Rijuneeta, G Grover
difficulty in deglutition, foreign body, tablet
Rijuneeta, G Grover. Dysphagia following tablet ingestion: A Case Report Of Unusual Foreign Body. The Internet Journal of Otorhinolaryngology. 2007 Volume 7 Number 2.
A foreign body in the cricopharynx causes severe discomfort to the patient and is a potential threat to the airway. There have been case reports of some unusual foreign bodies like press through package which is commonly used as a package for drugs, fork, drug filled packets, medicine bottle cap and blister wrapped tablet. This is a unique case report because of the fact that the foreign body tablet was not wrapped; even then it got impacted and led to dysphagia and odynophagia.
Foreign body obstruction at the level of the cricopharynx is not an uncommon presentation in the accident and emergency department. A foreign body in the cricopharynx causes severe discomfort to the patient and is a potential threat to the airway. Its removal should be carried out as soon as possible since the pooled saliva can obstruct the airway 1 . Whether accidentally or intentionally, almost everyone living on this planet would have swallowed at least one foreign body in his lifetime 2 . Depending on their nature, foreign bodies may either have uneventful gastrointestinal transitions or be impacted in a particular segment of the gut 2 . The type of ingested foreign bodies commonly encountered varies from one society to another, each with their peculiar range of oral intruders determined by a host of cultural factors – psychosocial and dietary being the most important 2 . Esophageal foreign bodies are common in children and some specific groups of adults, such as prisoners or those with underlying esophageal disease, mental retardation and psychiatric illnesses 3 . We present here a rare foreign body lodged in cricopharynx. This was an ayurvedic tablet. which is commonly used in India for day to day health problems. Ayurveda or Ayurvedic medicine is an ancient system of health care that is native to the Indian subcontinent. It is presently in daily use by millions of people in India, Nepal, Sri Lanka. The word “Ayurveda” is a compound of the word ?yus meaning “life”, and the word veda, which refers to a system of “knowledge”. Thus “Ayurveda” roughly translates as the “knowledge of life”. In an extensive review of literature we did not come across any such foreign body being reported in English literature. This is an effort to further our knowledge of the possibility of this rare foreign body and the specific problems in its management.
A 20 year old female patient presented to our emergency with complaints of absolute dysphagia following ingestion of an ayurvedic tablet given by her mother in law for pain in abdomen. Just after ingestion of tablet the patient felt that the tablet had got stuck into her throat. The feeling of obstruction gradually increased so much so that she developed difficulty in deglutition followed by absolute dysphagia, and was unable to swallow even her saliva. Patient was immediately rushed to a local hospital, where flexible endoscopy was done and unsuccessful foreign body removal was attempted. The patient was then referred to our centre. By the time the patient came to us 8 hours had already passed and the patient had not taken anything per oral since then. The patient was in a state of distress and was having repeated feeling of vomiting out the foreign body but it did not come out. Indirect laryngoscopic examination revealed pooling of saliva in both pyriform sinuses. X ray lateral view neck revealed prevertebral widening in region of fifth and sixth cervical vertebrae ( figure 1).
Flexible endoscopy photographs revealed pooling of saliva in pyriform sinus ( figure 2).
Another picture revealed foreign body impacted in cricopharynx Figure 3.
Rigid hypophayrngoscopy was then done under general anesthesia and with the help of foreign body holding forcep, foreign body was removed. When initial attempts were made to take grip of foreign body the tablet broke and came out in pieces, finally as the size of tablet decreased it got disimpacted from the wall of cricopharynx and came out as one large piece approximately 2 cm in size (figure 4)
The foreign body was swollen, due probably to hygroscopic action of some chemicals in the ayurvedic tablet. Post operative the patient had immediate relief of symptoms and the patient was able to take well orally.
Foreign body ingestions or insertions are seen in four broad categories of patients:
We conclude that rarely foreign bodies like tablet, can get impacted in cricopharynx especially ayurvedic tablets which are commonly used in Asian countries especially India. These tablets probably contain some hygroscopic substances which can make them swell and lead to impaction at cricopharynx and obstruction. This is an attempt to further our experience in managing such an unusual foreign body.
Dr Rijuneeta, Assistant Professor, Department Of Otorhinolaryngology and Head and Neck Surgery, PGIMER, Chandigarh – 160012 India. Phone no.: 91-172-2756760. Mobile no.: 09855157508. Email ID: firstname.lastname@example.org Fax no.: 91-172-2744401.