Beef Meat Oesophageal Foreign Body Impaction In An Infant

摘要

Ingestion of foreign body is common and the oesophagus is the commonest site of impaction in the upper gastrointestinal tract. We present the case of a 12 month old boy who was fed beef meat and subsequently experienced persistent regurgitation which prompted radiological examination. Barium swallow examination under fluoroscopic guidance confirmed foreign body impaction, and he subsequently had endoscopic retrieval under general anesthesia. We emphasize the importance of radiological imaging in establishing an early diagnosis and effecting prompt treatment to prevent complications. This case is presented because of the rarity of beef meat bolus causing oesophageal impaction in infancy, and to highlight the role of imaging in the management of this condition. The literature was also reviewed. Introduction Foreign body ingestion is a common occurrence in the pediatric age group, with boys almost twice as frequently affected as girls; and coin is the most commonly ingested foreign body [1]. Other materials that may be impacted in the oesophagus include button batteries, fish bone, marble, bran, and guar gum [2-6]. Early treatment is advocated to avert serious morbidity and even mortality in some cases. However presentation may be delayed for variable periods of up to twenty years [7]. Three-fourths (75%) of all upper gastrointestinal tract foreign bodies are impacted in the oesophagus, while 16% are found in the pharynx; and 8% and 1% in the stomach and small intestine respectively [8]. Fish bone impaction in the oesophagus has been described in a seven month old infant [3]. Beef meat foreign body impaction in the oesophagus is rare in infancy in the medical literature. We report this case of impaction of meat bolus to highlight the potential risks involved in feeding infants with unmashed beef; and to emphasize the role of radiological imaging in establishing an early diagnosis to effect prompt treatment. Case Report A twelve-month-old boy was referred by the otorhinolaryngologist to the Bola Tinubu Health and Diagnostic Centre, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria, for barium swallow examination. The clinical indication was persistent regurgitation at every attempt at feeding after being fed with beef meat by a neighbour a day earlier. A total of 10 mls of barium sulphate solution (Baritop) was administered through a nasogastric tube under fluoroscopic control. Supine anteroposterior and lateral views of the oesophagus were obtained during the dynamic study. Findings revealed distension of the distal third of the oesophagus by a well-marginated intraluminal filling defect measuring 23 x 17 mm in diameter. This was at approximately 45 mm proximal to the gastroesophageal junction. Barium sulphate was seen to track around the filling defect to outline the distal oesophagus and stomach. There was no extraluminal collection of contrast medium to suggest perforation. The radiological diagnosis was distal third oesophageal foreign body impaction (Figures 1-4). He subsequently had endoscopic retrieval of the beef under general anesthesia, and the infant was relieved.