AN UNUSUAL CASE OF A MISSED ESOPHAGEAL FOREIGN BODY PRESENTING WITH A BRAIN ABSCESS

Mpho Magidi, Mariza de Villiers, Lola Chuma

University of Pretoria and Steve Biko Academic Hospital. Division of Pediatric Surgery

Abstract

Introduction: Foreign body ingestion is a common occurrence in children. Majority of the ingested foreign bodies usually pass spontaneously without complications. One percent of these ingested foreign bodies result in life threatening complications such as esophageal perforation, tracheoesophageal fistula, esophago-vascular fistula (EVF), extraluminal migration, penetration into adjacent organs and death. EVF typically

presents with massive upper gastrointestinal bleeding.

Case presentation: We present a case of a 2-year 6-month-old boy with a missed sharp foreign body, an open safety pin, in the esophagus with an unusual presentation. The pin perforated the esophageal wall into the right common carotid artery and caused a pseudoaneurysm. This patient presented with a right parietal brain abscess and neurological fallout. The brain abscess was drained, the safety pin removed and the pseudoaneurysm resected with primary repair of the common carotid artery.

Conclusion: EVF is rare and has a high mortality. There are no standardized protocols to manage these cases. We advocate for a multidisciplinary team approach and individualizing the management of each case.