Notorious Foreign Body in the Cricopharynx with Impending Internal Carotid Artery Penetration: A Case Report

Abstract

The presence of foreign bodies in the throat is a relatively frequent occurrence in otolaryngology practice. Adults experience foreign bodies in their throats more frequently, with food impaction being the main reason. A 60-year-old female presented with a history of fish ingestion and complaints of Foreign Body (FB) sensation in the throat and painful swallowing. Computed Tomography (CT) of the neck showed the presence of a FB in the hypopharynx, with a possibility of penetration into the parapharyngeal space and the left Internal Carotid Artery (ICA). The patient underwent FB removal under flexible fibreoptic endoscopy with intravenous sedation. Any delay in diagnosis and treatment could lead to the migration of the FB into the carotid artery, resulting in catastrophic bleeding. Hence, every patient who visits the otolaryngology Outpatient Department (OPD) with complaints of FB sensation in their throat needs to be evaluated promptly. Physicians should be particularly concerned if the patient has prolonged clinical symptoms, positive neck radiography, and negative direct laryngoscopy and rigid esophagoscopy. These cases have a high index of suspicion for a migrating FB. Whether to consider segmental resection and end-to-end anastomosis, angioplasty with a saphenous vein or prosthetic patch, insertion of an allograft, Polytetrafluoroethylene (PTFE) interposition graft, or replacement of the injured ICA will depend on the type and extent of the arterial injury.

Keywords

• polytetrafluoroethylene graft
• prosthetic patch
• proton pump inhibitors
• segmental resection