Chronic esophageal foreign bodies and secondary mediastinitis in children.

OBJECTIVES: The purpose of this study was to review the clinical presentation, diagnosis, and management of chronic esophageal foreign bodies complicated by mediastinitis in children.

METHODS: A retrospective study of children with a chronic esophageal foreign body and secondary mediastinal complications diagnosed at Rady Children's Hospital in San Diego over a 12-month period is reported.

RESULTS: Three patients received a diagnosis of an esophageal foreign body, retained from 1 to 12 months, and mediastinitis. Each patient presented primarily with respiratory signs and had been treated previously for alternate diagnoses (ie, asthma, reflux, and upper respiratory tract infection) by emergency or pediatric providers. The diagnosis of a foreign body was made after a chest radiograph was examined. Operative airway evaluation confirmed tracheal narrowing in all patients, and a computed tomographic scan of the chest was performed after removal of the foreign body to confirm mediastinal involvement. After medical and/or surgical treatment, the patients were released from the hospital tolerating soft diets. There were no reports of long-term complications in our series of patients.

CONCLUSIONS: It is critical to rule out esophageal and airway foreign bodies in pediatric patients with respiratory symptoms that do not respond to medical treatment. Timely recognition of an esophageal foreign body generally allows for removal with minimal morbidity, whereas the incidence of serious complications increases significantly when the diagnosis is delayed. Our series provides support for conservative management of mediastinal complications after removal of chronically retained esophageal foreign bodies in children.