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Ornament hook stuck in infant's throat for months led to seizures, brain lesions

A 10-month-old child had an ornament hook stuck in her esophagus for several months before anyone discovered it. On the left, an X-ray of the child's chest showing the metal ornament hook (arrow), and on the right, a photo of the hook after it was removed.
A 10-month-old child had an ornament hook stuck in her esophagus for several months before anyone discovered it. On the left, an X-ray of the child's chest showing the metal ornament hook (arrow), and on the right, a photo of the hook after it was removed.
(Image: © Reprinted with permission of Elsevier (2020).)

A 10-month-old child had an ornament hook stuck in her esophagus for several months before anyone discovered it, according to a new report of the case.

The hook tore a hole in her esophagus, which caused an infection that spread to her brain and led to seizures, the report said. Fortunately, the child recovered after the hook was removed.

The child's parents brought her to the emergency room after they saw her have a seizure for the first time, according to the report, published July 18 in The Journal of Emergency Medicine. By this point, the child had been sick for a while — two months earlier, she began to experience frequent fevers of up to 102 degrees Fahrenheit (38.9 degrees Celsius) along with vomiting, gagging and aversion to solid foods, according to the authors, from the University of Colorado School of Medicine. During this 2-month period, the child lost more than 1 lb. (500 grams).

At the emergency room, the child had a slight fever, and blood tests showed signs of an infection. A CT scan showed six lesions in the child's brain, with the largest measuring 1.5 inches (4 centimeters) in diameter. These turned out to be brain abscesses caused by a bacterial infection. The doctors gave the child antibiotics and drained fluid from some of the abscesses during a brain surgery.

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A CT scan of the infant's brain showing multiple brain abscesses.

A CT scan of the infant's brain showing multiple brain abscesses. (Image credit: Reprinted with permission of Elsevier (2020).)

After the surgery, they transferred the child to the pediatric intensive care unit, where a routine chest X-ray revealed a foreign body in her esophagus. The child underwent yet another procedure to remove the foreign body, which was found to be a metal ornament hook. The hook had perforated her esophagus and caused inflammation in her chest cavity. The child had to be fed through a nasal tube until her esophagus healed.

Brain abscesses are rare in children, but sometimes occur when infections spread from the ear or the sinuses to the brain. However in this case, the researchers think that the infection spread through the bloodstream to the brain.

Foreign bodies that aren't passed within 24 hours have a higher risk of causing complications such as infection. Doctors should consider the possibility that a patient has ingested or inhaled a foreign body if the person has a history of cough, gagging, vomiting and decreased food intake, the authors said.

"Earlier detection and removal of foreign bodies are essential to preventing subsequent complications," they wrote.

The child was able to eat again one week after the hook was removed. She continued antibiotics after she left the hospital and hasn't had any more seizures. Some of her brain lesions were not able to be drained because they were caused by inflammation rather than a collection of fluid, and the largest of these lesions decreased in size from 1.1 inch (2.9 cm) to 0.02 inch (0.05 cm) after three months. The child continues to meet developmental milestones and has no neurologic impairments, researchers wrote in the study.

Originally published on Live Science.