The Wandering Foreign Body: A Seemingly Spontaneous Migration from Bronchus to Stomach in a Child

Abstract

A 12-year-old previously healthy male presented to a refer-ring emergency department (ED) after reporting that he suddenly “ breathed in a piece of a toy ” while riding in a car. The child had removed a metal pin from a “ fi dget cube ” and was chewing on it. The car was jarred as it drove over a bump, leading him to inhale the metal pin. In the ED, a chest radiograph obtained around 2000 revealed a cylindrical, radiopaque foreign body (FB) in his right bronchus ( ► Fig. 1 ). The child denied shortness of breath, chest pain,orany discomfort. Hehadnocoughingor vomiting. His vital signs were stable, and his oxygen saturation was 99% on room air. The child was transferred to our pediatric intensive care unit (PICU) for close monitoring and further evaluation by the pediatric otolaryngology staff. Upon arrival to the PICU, the child remained without distress and reported no coughing or vomiting during trans-port. The child was monitored overnight and taken to the operating room early the next morning. Under general endotracheal anesthesia, a 13.5 slotted Storz laryngoscope was used to evaluate the pharynx, larynx, and periglottic regions and no abnormalities were noted. A long Hopkins telescope was then used to examine the trachea and both right and left mainstem bronchi. No FB or signs of in fl am-mation were identi fi ed. An intraoperative chest radiograph obtained around 0900 revealed that the FB was now in the stomach ( ► Fig. 2 ). The pediatric gastroenterology service was consulted and suggested that the FB did not require removal, as