title: Chronic cervical esophageal foreign bodies in children: surgical approach after unsuccessful endoscopic management.
abstract: OBJECTIVE
  We reviewed the surgical management of chronic cervical esophageal foreign bodies (CCEFBs) in a pediatric population after failed endoscopic retrieval.
  
  
  METHODS
  A descriptive analysis via a retrospective chart review of patients with CCEFBs who failed initial endoscopic management was performed between 2008 and 2013. Details were recorded regarding presenting symptoms, time from symptom onset to diagnosis of the CCEFB, surgical approach, and complications.
  
  
  RESULTS
  Three patients with CCEFBs unsuccessfully managed with endoscopy were identified. The range of ages at diagnosis was 14 months to 4.5 years. The foreign bodies (FBs) were present for at least 1 month before diagnosis (range, 1 to 10 months). Respiratory symptoms were predominant in all cases. Neck exploration with removal of the FB was performed in each case. Complications included esophageal stricture necessitating serial dilations (patient 1), left true vocal fold paresis that resolved spontaneously (patient 3), and tracheoesophageal fistula with successful endoscopic closure (patient 3). No long-term sequelae were experienced.
  
  
  CONCLUSIONS
  A high index of suspicion is required to recognize CCEFBs in children with respiratory distress. Although endoscopic management remains the first-line treatment, it may fail or may not be possible because of transmural FB migration. In this setting, neck exploration with FB removal is a safe and effective alternative.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery (Schramm, Sewell), College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Jordan C
authors.initials: JC
authors.lastname: Schramm
authors.forename: Ryan K
authors.initials: RK
authors.lastname: Sewell
authors.forename: Kenneth S
authors.initials: KS
authors.lastname: Azarow
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Raynor
authors.forename: Shahab F
authors.initials: SF
authors.lastname: Abdessalam
mesh_terms: D002675:Child, Preschool; D002908:Chronic Disease; D004940:Esophageal Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D004945:Esophagoscopy; D004947:Esophagus; D005260:Female; D005547:Foreign Bodies / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods; D011859:Radiography; D012189:Retrospective Studies; D014138:Tracheoesophageal Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D017211:Treatment Failure; D016896:Treatment Outcome
keywords: chronic illness; foreign body; infant; ingestion; injury; neck; preschool child