Pediatric pharyngeal foreign body with a difficult diagnosis

A 1-year-old boy with Down syndrome visited the emergency department of our hospital with complaints of displeasure and suspicion of pharyngeal foreign body obstruction. The parents noticed that a clothing price tag was missing at home. At the time of the initial examination, no foreign bodies were detected in the oral cavity of the patient. In addition, computed tomography did not reveal any foreign bodies (Figure 1A). The patient was referred to our department the next day. Endoscopic examination revealed a plastic foreign body at the posterior pharyngeal wall (Figure 1B). We could observe the foreign body from the oral cavity, and the foreign body was removed from the oral cavity using forceps, avoiding the huge tongue (Figure 1C). Pharyngeal foreign body obstruction usually manifests as dysphagia, vomiting, and drooling.1 Typical pharyngeal foreign bodies include food, toys, balloons, and plastic bags. The patient had Down syndrome, and consequently, his enlarged tongue posed difficulties for oral observation. The foreign body was plastic and transparent, and it is difficult to see the foreign body in the emergency department. This case was characterized by the difficulty of diagnosis due to the presence of a transparent plastic foreign body and a large tongue, and there was a risk of the foreign body blocking and moving to the larynx. It was suggested that this case showed the need for early intervention by an otolaryngologist in the emergency outpatient department and the importance of performing an endoscopy as soon as possible. In addition, we should consider the possibility of performing an endoscopy before a CT scan to avoid radiation exposure. None. The authors declare no conflicts of interest. Approval of the research protocol: N/A. Informed consent: Informed consent was obtained from the patient's family. Registry and the registration number of the study/trial: N/A. Animal studies: N/A. The data that support the findings of this study are available from the corresponding author upon reasonable request.