Using an image-guided percutaneous approach to retrieve ingested extra-esophageal metal bristle
Diagnostic imaging plays a critical role in identifying and locating an ingested object so that it can be safely removed. Interventional radiologists used a novel, image-guided, minimally invasive percutaneous approach to safely remove a piece of metal from outside the esophagus of a child after a failed esophageoscopy. They described the technique in the May 17, 2019, online edition of Pediatric Radiology.
David Volders, MD, and Manraj K.S. Heran, MD, intervetional radiologists at the British Columbia Children’s Hospital in Vancouver, were called into action when an attempt by an otolaryngologist to retrieve a metal bristle from a barbecue cleaning brush lodged in the esophagus of an 8-year-old boy. During the attempted retrieval, the bristle was pushed outside the esophagus. Its new location, just posterior and adjacent to the ipsilateral common carotid artery, was identified by contrast-enhanced computed tomography (CT). Such migration can cause bleeding and abscess formation.
Drs. Volders and Heran used high-resolution ultrasound and three-dimensional (3D) C-arm CT rotation with associated needle guidance technology to place an access port. The team broke off the hub of a 22-gauge, 5-inch Chiba needle, and placed a 7-Fr, 6 cm vascular sheath with the valved hub cut off over the needle. They explained that the needle was fixed while advancing the dilator/sheath combination in a spinning rotation. To allow the sheath to serve as a port, the dilator and Chiba needle were removed. A 3-Fr endourology alligator forceps was advanced under fluoroscopy, and the foreign object was removed.
“The use of ultrasound further aided in avoiding potentially catastrophic vascular injury, allowing for optimal real-time imaging of the ipsilateral common carotid artery and internal jugular vein upon needle and sheath advancement,” wrote the authors. “We believe our approach is also applicable in situations of less radiopaque foreign bodes, such as chicken bones. It has the potential to be used in other body areas as well as to minimize tissue trauma.”
REFERENCE
- Volders D, Heran MKS. A novel percuntaneous approach to retrieve an ingested extra-esophageal foreign body. Pediatr Radiol. Published online May 17, 2019. doi: 10.1007/s00247-019-04416-2.