Fish and chicken bones, along with metal wires, are among the most commonly ingested foreign bodies. Due to their linear shape and sharp edges, they can sometimes migrate beyond the lumen, making conventional endoscopic extraction unsuccessful. This issue is further complicated when patients delay seeking medical attention. In that time, symptoms can evolve from the usual sharp neck pain, throat irritation and dysphagia to dull neck pain, particularly when turning the head. In some cases, the condition may be misdiagnosed, as seen in a patient who was treated for laryngopharyngeal reflux for five years before the true cause was identified. Another patient with a foreign body lodged in the thyroid was mistakenly treated for thyrotoxicosis. In an unusual case, a foreign body even migrated into the parotid gland. Muscle contractions can cause foreign bodies to shift, sometimes pushing them entirely out of the lumen. Of the 15 patients studied, two presented with frank retropharyngeal abscess. Surgical exploration of the neck can be particularly challenging in these cases. Ordinary x-rays are often unhelpful, while CT scans provide better visualisation. However, the location of the foreign body may shift depending on the patient’s position on the operating table. The use of a C-arm intraoperatively to localise the foreign body in the neck is recommended. The key takeaway is that in patients with a known history of ingestion and persistent, even vague, symptoms, the possibility of extra-luminal migration must be taken seriously. Timely imaging and appropriate surgical intervention are crucial.
Wandering foreign bodies in the upper aerodigestive tract
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