We report a rare instance of nine foreign bodies in a neonate that included a coin, safety pin, screw, cotton piece, polythene piece, and four glass pieces. Of these, six foreign bodies were removed by esophagoscopy and endoscopy, two glass pieces were passed in feces and one could not be removed. The child died 5 days after admission.

Keywords: Esophagus, Foreign body, Gastrointestinal tract, Newborn.

A 12 day-old female child having normal parents, presented with a complaint of recurrent vomiting , fever and respiratory distress for 11 days. During this period of 11 days she was treated by many pediatricians, with antibiotics and other supporting medicines. On admission, the general condition was poor and she was put on antibiotics and CPAP. Chest X-ray revealed three metallic foreign bodies (a coin, safety pin, and screw) in the upper, mid-esophagus and near the cardiac end of esophagus (Fig. 1). The patient was then referred to ENT Department and five foreign bodies (coin , safety pin, screw, cotton piece, polythene piece) (Fig. 2) were removed by rigid esophagoscopy. A repeat chest X-ray after the procedure suggested some opaque shadows at cardiac end of esophagus and stomach. A gastroenterologist was consulted who could remove one glass piece from stomach by fibreoptic endoscopy. One sharp edged glass foreign body could not be removed because of the risk of esophageal tear. Two small glass pieces were recovered in feces. Thus a total of nine foreign bodies were identified in the gastrointestinal tract of this new born female child, of which 8 were removed/expelled. Condition of the child deteriorated and she died after five days of admission.

Fig. 1 X-ray chest PA view showing multiple foreign bodies (rounded shadow, safety pin, screw, cotton piece).

Inspite repeated questioning, the attendants and relatives vehemently denied any act of deliberate introduction of foreign bodies in the mouth of the newborn. However, the police has registered a case of murder and started investigations.

Fig. 2 Photograph of cotton piece, coin, polythene piece, safety pin and screw removed from the esophagus and stomach by the help of endoscope.

Foreign bodies in the esophagus are mostly accidental and usually occur in older children and adults(1-3). Multiple foreign bodies in esophagus have been reported earlier(4,5), however, we did not come across any instance of esophageal foreign bodies in a 12 day old neonate.

Though we were not able to ascertain the cause, it appeared to be a homicidal act. Family members were not suffering from any psychiatric illness. A detailed medicolegal investigation is warranted in such cases.

Contributors: AM managed the case, kept records and wrote the paper. PPG and RKG help in collecting data, literature review and manuscript preparation.

Funding: None.

Competing interests: None stated.