Clinical manifestations and therapeutic approaches for migratory cervical foreign bodies com-plicating esophageal perforation

Ma Dengbin; Wei Yanan; Li Jiayi; Gu Yajun; Shen Xiaohui; Qian Xiaoyun; Gao Xia

doi:10.3969/j.issn.1009-4237.2025.11.004

Abstract：Objective To summarize the clinical characteristics,diagnostic and therapeutic approaches,and associated risk factors of migratory cervical foreign bodies secondary to esophageal perforation.Methods A retro-spective analysis was conducted on 74 patients with ingested foreign bodies admitted to our department between Jan.2018 and Jan.2025.Among them,31 cases(13 males,18 females;mean age 60.9 years,ranging 29-91 years)ex-hibited esophageal perforation with migratory cervical foreign bodies into the periesophageal tissues,as confirmed by preoperative cervical CT.A control group of 43 patients(18 males,25 females;mean age 58.7 years,ranging 24-90 years)with esophageal foreign bodies admitted during the same period,as indicated by CT,was included.Surgical strategies were tailored based on the location of the foreign body.Basic data,surgical details,postoperative complica-tions,and clinical outcomes were collected.The two groups were compared regarding the types of ingested foreign bodies,mean initial medical consultation time,duration of nasogastric tube retention,and hospitalization length.Risk factors for foreign body migration were analyzed.Results Clinical manifestations of the 31 patients with migratory cervical foreign bodies included odynophagia in 20 cases(64.5%),foreign body sensation in 17 cases(54.8%),neck pain in 13 cases(41.9%),fever in 6 cases(19.4%),and dyspnea in 3 cases(9.7%).The types of foreign bodies were fish bones in 25 cases(80.6%),metal wires in 3 cases(9.7%),and chicken bones in 3 cases(9.7%).Complications arising from migratory cervical foreign bodies included neck abscess in 11 cases(35.5%),mediastinal abscess in 5 cases(16.1%),and retropharyngeal abscess in 1 case(3.2%).All the 31 pa-tients underwent lateral neck incision for foreign body removal,with concurrent abscess incision and drainage per-formed when neck or mediastinal abscesses were present.Postoperative complications mainly included hoarseness in 1 case(3.2%)and choking during eating in 3 cases(9.7%).In contrast,patients with esophageal foreign bodies primarily presented with pharyngeal pain,odynophagia,foreign body sensation,and localized neck pain.The types of foreign bodies in this group included fish bones in 29 cases(67.4%),chicken bones in 5 cases(11.6%),duck bones in 4 cases(9.3%),pork bones in 2 cases(4.7%),jujube pits in 2 cases(4.7%),and dentures in 1 case(2.3%).No significant preoperative complication was observed in this group,and esophagoscopic foreign body re-moval was performed without notable postoperative complications.Compared to patients with esophageal foreign bodies(n=43),those with migratory cervical foreign bodies(n=31)showed that fish bone ingestion[25(80.6%)vs.29(67.4%),OR=2.01]and initial medical consultation time>24 h[27(87.1%)vs.9(20.9%),OR=25.50]were significant risk factors for foreign body migration outside the esophagus(all P<0.001).Conclusion Esophageal impaction of ingested foreign bodies predominantly involves sharp objects.Sharp foreign bodies and an initial medical consultation time>24 h are risk factors for esophageal perforation and foreign body migration.Migratory cervical foreign bodies require open surgical intervention,with favorable surgical out-comes.Esophageal foreign bodies should be managed promptly to prevent migration and severe complications.