CASE SUMMARY
A 2‐year‐old girl presented to a regional hospital with a single low‐abundance hematemesis. Parents noted a loss of appetite and dietary vomiting during the past 5 days. Initial clinical examination and blood tests were normal. The child was admitted for surveillance. A few hours later, she suddenly collapsed with recurrent abundant hematemesis. Hemodynamic was rapidly stabilized after fluid resuscitation and blood transfusion and the child was medically retrieved to the regional pediatric ICU. Transport was uneventful, but a few minutes after admission, she collapsed and arrested. Despite immediate cardiopulmonary resuscitation, she ultimately died.
DIAGNOSIS
Post mortem chest x‐ray was normal (Figure 1). Medico‐legal autopsy (Figure 1) revealed the existence of a V‐shaped cartilaginous foreign body, measuring 3 cm in its longest length, stuck in the middle part of the esophagus, with each of the branches perforating the esophageal mucosa, and 1 of which was perforating the aortic mucosa at the level of the aortic isthmus, realizing an aorto‐esophageal fistula.
FIGURE 1.
Thoraco‐abdominal post mortem x‐ray and autopsy findings. No radiopaque foreign body was shown on x‐ray (A). Autopsy findings showing esophageal (B) and aortic isthmic (C) perforations attributed to a V‐shaped cartilaginous foreign body (D) stuck in the middle part of the esophagus (E).
Acute upper gastrointestinal bleeding is a serious condition, and the presence of a non‐radiopaque foreign body must always be mentioned in front of prolonged food intolerance, especially in children between 1 and 5 years of age.
Barreault S, Marais C, Rambaud C, Tissières P. Child with loss of appetite and dietary vomiting. JACEP Open. 2020;1:1143–1144. 10.1002/emp2.12240