Figure 3: Operative photograph showing retrieval of iron wire.

Figure 4: Iron wire removed by Oesophagotomy

Figure 2: Showing oesophageal perforation and retrieval of wire from external side

Figure 1: Lateral view- Wire of iron out side of the mouth

Abstract

Objective: To report a rare case of impacted foreign body (Iron wire) in the oesophagus and review the literature.
Case Report: This is a case report of impacted foreign body (Iron wire) in the oesophagus. The wire could be seen on out side of the mouth in the buffalo calf. The owner and other peoples has tried to remove the wire by force and approaching manually through mouth has not succeded to remove the iron wire. Case is later on referred to Hassanian Veterinary Hospital Mircolony Tandojam, Pakistan. Foreign body (iron wire) was removed by Oesophagotomy and retrieval of iron wire via external approach.
Conclusion: Foreign body ingestion is a common problem. Early removal of foreign bodies must be considered to reduce the risk of complications. Impacted iron wire in buffalo calf in the oesophagus which was removed by oesophagotomy is an unusual presentation. To the best of my knowledge this is the first case report from Pakistan.

Introduction

Foreign body ingestion is a common problem ¹ . Most common foreign bodies in pediatric age group are coins ²,³but meat bone, marbles, safety pins, button, batteries and screws are also reported. Adhikari et al study also showed coins and denture as a common foreign body in adults ⁴ . Foreign body ingestion is a common occurrence and carries significant morbidity and mortality. Sharp Foreign Bodies is frequently associated with serious complications ⁴ . If they are not removed at the earliest, they can cause erosion, perforation, abscess or mediastinitis ³ . Early removal of these Foreign Bodies must be considered to reduce the risk of complication ⁴ . I report a case of impacted foreign body (ron wire) in the oesophagus of buffalo calf. To the best of my knowledge this is the first case report from Pakistan.

Case Report

A one month old female buffalo calf presented to Hassanian Veterinary Hospital, Mircolony Tandojam, Pakistan with the history of gradually progressive dysphagia, odynophagia and pain in the neck after the accidentally ingested iron wire. One end of the iron wire was out side of the mouth and other curved end of the wire is palpable in the oesophagus. There was no history of fever, drooling of saliva, shortness of breath, seizures. On examination, the patient was ill looking. Throat and neck examination revealed tenderness over the neck. Other examinations were normal. On physical examination iron wire was present at the level of 6 ^th and 7 ^th cervical vertebra.( Fig:1). Other routine investigations were normal.

With the diagnosis of foreign body (iron wire) in oesophagus, calf was operated under general anesthesia. The wire of the iron was impacted on lateral wall of oesophagus and wire could not be removed. After 5 hours the calf underwent oesophagotomy and retrieval of the wire via external approach.

Small incision was performed by pushing the wire and approaching from external side. The incision was closed in layers and dressing applied. Fig. 4 showed the iron wire of 18 inches long after removal by oesophagotomy.Post operatively intramuscular antibiotics were continued for 2 days and milk feeding was given in morning and evening. suture was removed on 7 ^th postoperative days. The calf was discharged on the same day surgery without any problem.

Conclusion

Impacted iron wire in the oesophagus which was removed by oesophagotomy is an unusual presentation. To prevent accidental ingestion, dentures should be made to fit properly and damaged or malfitting dentures should be discarded and replaced. Patients should be strongly advised against wearing them in bed.

References

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2. Yang CY. The management of ingested foreign bodies in the upper digestive tract: a retrospective study of 49 cases. Singapore Med J 1991; 32: 312-5. (s)

3. Guitron A, Adalid R, Huerta F, Macias M, Sanchez Navarrete M, Nares J. Extraction of foreign bodies in the esophagus: Experience in 215 cases. Rev Gastroenterol Mex 1996; 61:19-26. (s)

4. Prakash Adhikari, Bikash L. Shrestha, D.K. Baskota, Bimal.K.Sinha.Accidental foreign body ingestion: analysis of 163 cases. Int Archieves of Otorhinolaryngol 2007; 11(3):267-0. (s)