Late migration of an aspirated foreign body from the lung to the bowel: A plausible explanation or a medical mystery. A case report

Introduction and importance: Foreign body (FB) aspiration is a common preventable cause of death among children between ages 1–3 years. A rare case of an aspirated sharp metallic object in a 4-year-old boy that migrated from the left lung to the GIT after a year is presented after bronchoscopy and thoracotomy failed to retrieve it. Presentation of case: A 4-year-old boy presented with cough a year after aspirating a sewing machine needle. He was stable with normal chest findings. Previous bronchoscopy attempts failed to retrieve the needle. A thoracotomy was done after a chest CT revealed the foreign body in the left lower lobe. FB could not be palpated nor visualized intraoperatively. Flexible bronchoscopy could also not visualize the needle in the airway. A postoperative x-ray done revealed the needle was no longer in the chest but in the bowel. Clinical discussion: Bronchoscopy is the standard treatment for FB aspiration but in our case, it failed on two occasions to retrieve the sharp object. Our literature search revealed only reported cases of migrating FB from one bronchus to the other, and from the bronchus to the gastrointestinal tract (GIT) but not from the lung into the GIT. Conclusion: FB migration from the lung to the GIT after a year without signs of perforation is possible. While we brainstorm the plausible explanations for this migration, one may wonder if this is just a medical mystery.