A 10-month-old infant had presented to the emergency department with a first-time seizure, the cause of which was found to be a brain abscess. However, doctors were left stunned when a routine chest X-ray revealed the presence of a foreign body in her throat which had likely been stuck there for several months.
Foreign bodies are believed to be the fourth most common pediatric emergency according to the American Association of Poison Control Centers. While most foreign bodies pass spontaneously through the gastrointestinal tract, those retained for over 24 hours are linked to complications such as obstruction, perforation, peritonitis, and even abscesses.
According to the study published in The Journal of Emergency Medicine, the infant had an ornament hook stuck in her throat for several months that resulted in not only a hole in her esophagus but also multiple brain abscesses.
The parents reported that for the past two months the infant had been experiencing frequent fevers that went up to 102.4 degrees Fahrenheit, vomiting, aversion to solid food, gagging and, impaired growth which had led her to lose about 500grams of weight.
A CT scan performed upon admission revealed six ring-enhancing lesions in the brain of the infant, with the largest measuring up to 4cm in diameter. The blood tests combined with the CT scan results confirmed it to be brain abscesses caused by a bacterial infection. An emergent craniotomy was conducted, and the abscesses were drained.
After surgery, a routine chest x-ray revealed a foreign body in the esophagus. An esophagoscopy was then conducted which identified the foreign body as a metal ornament hook. MRI including angiography confirmed the presence of an esophageal perforation at the site. The perforation seemed to have caused inflammation in her chest cavity which had spread to the brain via the bloodstream.
Fortunately, the infant was seen to recover after the removal of the hook. The size of the brain abscesses was also seen to decrease prior to her discharge and no seizures were recorded.
While brain abscesses are rare in the pediatric setting, they can result as a severe complication of esophageal perforation due to a foreign body. Researchers believe that doctors should always consider foreign body ingestion or aspiration in children with a history of cough, gagging, vomiting and, aversion to food as early removal can prevent complications. Additionally, brain abscess should be considered in patients with concerns about previous foreign body ingestion and, those with newly developed neurological symptoms.
Shah, P. V., Wathen, J., Keyes, J., Osborne, C., Messacar, K., Stence, N., & Kothari, K. (2020). Foreign Body Esophageal Perforation Leading to Multifocal Brain Abscesses: A Case Report. The Journal of Emergency Medicine. doi:10.1016/j.jemermed.2020.06.025