A prickly situation: an attempted Caterpillar ingestion - case report
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(2020) 49:70
CASE REPORT
Open Access
A prickly situation: an attempted Caterpillar ingestion - case report Amar K. Bhardwaj1, Naif Fnais2,3 and Christopher J. Chin1,4,5*
Abstract Background: Foreign body ingestion is a common problem in pediatrics. Each foreign body can present its’ own unique challenges during removal, and we present the management of an ingested Spotted Tussock Moth (Lophocampa maculata), more commonly known as a caterpillar. Case presentation: An 18-month-old boy presented to the emergency department with difficulty handling secretions and odynophagia. It was reported he had placed a caterpillar in his mouth and then spat it out. On examination, hundreds of miniscule filaments (setae) were seen embedded in his lips and tongue. Our service was consulted out of concern for airway involvement. The patient was taken to the operating room where a direct laryngoscopy under general anesthesia with spontaneous ventilation was performed to confirm the setae were confined to the anterior tongue and lips. Once we were satisfied the airway was stable, the airway was secured, and we then began to remove the setae. The initial method used was to use Adson-Brown forceps to remove the setae, however this proved difficult and time-consuming given the volume of setae and how thin the setae were. Ultimately, a more effective technique was developed: a 4 × 4 AMD-RITMES® gauze was applied to the mucosa in order to dry up any secretions and then a piece of pink, waterproof BSN medical® tape was applied to the mucosa. After 3 s of contact it was removed. This technique was then repeated and was used to remove the vast majority of the setae. Conclusion: To our knowledge, we have described the first technique to remove the caterpillar setae from the oral cavity mucosa in a fast, safe and efficient manner. Keywords: Foreign body ingestion, Caterpillar, Otolaryngology, Case report
Background Foreign body (FB) ingestion is a common problem in pediatrics and can present with upper airway obstruction. The presentation is variable depending on the FB, and whether the FB is aspirated on ingestion, but it can present with drooling, choking, dysphagia, odynophagia and chest pain. We present an unusual case of a (fortunately) failed attempt to ingest a caterpillar in an 18month-old boy. The case highlights the difficulty in * Correspondence: [email protected] 1 Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada 4 Department of Surgery, Division of Otolaryngology – Head and Neck Surgery, Saint John, New Brunswick, Canada Full list of author information is available at the end of the article
treating each unique FB, as the caterpillar ‘spines’ presented a challenge for removal.
Case presentation An 18-month-old boy presented to the emergency department with difficulty handling secretions and odynophagia. It was reported by his parents he had placed a caterpillar in his mouth and then spat it out. The caterpillar was identified as a Lophocampa maculata (Spotted tussock moth) by visual comparison to othe
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