{'fraction_non_alphanumeric': 0.01721170395869191, 'fraction_numerical': 0.004130808950086058, 'mean_word_length': 4.653696498054475, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
How Did It Get There? A Coiled Metal Foreign Body in an Unusual Cervical Position

A 50-year-old man was seen at the emergency department at Carmel Medical Center because of an FB sensation in his right throat and odynophagia after eating a hamburger in a restaurant 1 hour earlier. He had the feeling of something in his throat and introduced a finger in an attempt to take it out, but the feeling persisted. On examination the patient had no difficulty in breathing, but he said it was difficult for him to swallow. No FB or mucosal tear was evident in his mouth or pharynx. No fluctuance or crepitance of the cervical soft tissues was present. The patient was afebrile. Plain radiographs of the neck in the lateral and anteroposterior position were performed and both showed a 3-cm long hyperdense coiled FB in the right pharynx at the level of the first to third cervical vertebrae (Fig 1). Surprisingly the cranial end of the FB was located laterally whereas the caudal end was located medially, close to the mucosa of the hypopharynx. With the patient under general anesthesia, a rigid pharyngoscopy found no evidence of an FB in the pharynx or hypopharynx, and no injury site to the mucosa was seen. A CT of the neck using contrast material found the same FB tranversing the right parapharyngeal space and embedded in the vascular space, close to the external carotid artery. While hospitalized the patient was hemodynamically stable and afebrile, and his blood count showed no leukocytosis but he still complained of the same odynophagia. After 3 days of close follow-up, the patient was discharged with the rationale that if the feeling was not better in 10 days, a new CT scan and even surgery might be required. Because the patient continued to complain of odynophagia, a new tomography study was made in which the FB was found in close proximity to the external carotid artery, and it was decided to remove it. A transoral approach through the pharynx was taken behind the posterior tonsillar pillar and almost reaching the vascular space. The FB could not be located with a dynamic intraoperative fluoroscopy. Next an exploration of the neck was performed through the vascular space. Because of the access from both sides, an orocutaneous fistula was made. After the major vessels in the vascular space were controlled using the intraoperative stereotactic dynamic fluoroscopy, a 3-cm long metallic coiled FB was located in close vicinity to the external carotid artery and was carefully withdrawn (Fig 2). A drain was left in the neck, and because of the orocutaneous fistula, a nasogastric tube was introduced. The patient was fed enterally and antibiotics administered perioperatively. After 2 days the drain and the nasogastric tube were taken out without any evidence of fistula. The antibiotics were stopped, and the patient was discharged after 6 days. On followup he was symptom-free.