What medical hazard exists from outdoor grills?
Background: Esophageal foreign bodies are frequently encountered in the primary care and emergency department setting and commonly require otolaryngology consultation for removal. In children, coins are the most common esophageal foreign body; in adults, fish bone ingestion is most commonly reported. Wire bristles used to clean outdoor grills are a lesser known hazard. These can be inadvertently left on the grill and end up in grilled food.
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October 2012Study design: Six case studies at one institution.
Setting: Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, Penn.
Synopsis: The first case involved a 92-year-old female with dysphagia and cough following ingestion of grilled chicken. Plain films of the neck and chest revealed a metallic object lodged at the level of C7. A CT of the chest showed a 3 cm object penetrating the esophageal wall and lying in close proximity to the left common carotid artery. The object was removed surgically. In the second case, a 56-year-old female complained of throat pain for seven days following ingestion of grilled pork. X-rays suggested a foreign body was present, but flexible esophagoscopy did not reveal the object. CT scan revealed a thin metallic body lodged in the right pyriform sinus extending into the right thyroid lobe. The patient underwent rigid esophagoscopy. Case 3 involved an 18-year-old female with a one-week history of odynophagia and foreign body sensation after eating a hot dog. A CT scan revealed a thin, radiopaque object in the vallecula that was removed atraumatically with forceps. Case 4 was a 57-year-old male with a one-day history of foreign body sensation after eating grilled chicken. X-rays revealed the wire bristle, which was located in the second portion of the duodenum. The patient passed the wire without complication. A fifth case involved a 49-year-old male who experienced acute onset of foreign body sensation after eating grilled chicken. Although an X-ray of the neck was initially negative, repeat film revealed a thin linear density projecting over the supraglottic space. It was subsequently removed with endoscopic guidance. The last case was a 42-year-old female who, after eating grilled chicken, had acute onset of foreign body sensation and odynophagia two hours prior. An X-ray revealed a wire bristle superior to the hyoid bone, and removal was performed using forceps through the working port of a flexible scope.
Bottom line: Early involvement of the otolaryngologist with the endoscopic visualization and subsequent removal of the bristle may prevent migration, esophageal perforation and associated complications.
Reference: Harlor EJ, Lindemann TL, Kennedy TL. Outdoor grilling hazard: wire bristle esophageal foreign body—a report of six cases. Laryngoscope. 2012;122(10):2216-2218.