Incidental Double Foreign Bodies Obstruction in the Oesophagus: Unusual Presentations in a 3-Year-Old at Amana Regional Referral Hospital

Foreign body impaction in the oesophagus remains one of the most common paediatric medical emergencies and continues to be associated with significant morbidity and, in severe cases, mortality. Prompt recognition and emergency removal are therefore essential in order to prevent potentially life-threatening complications such as oesophageal perforation, mediastinitis, aspiration pneumonia, and strictures. Although the ingestion of a foreign body is often witnessed or reported, the diagnosis may occasionally be delayed or missed, particularly when the presentation is atypical or when initial symptoms are mild or absent. Such delays may lead to late diagnosis, misdiagnosis, and an increased risk of complications. We present a case of a 3-year-old female child who was brought to the hospital with a three-day history of postprandial vomiting accompanied by a persistent dry cough. Notably, two weeks prior to presentation, there was a history of foreign body ingestion. At that time, the child remained asymptomatic and was reassured at a lower-level health facility that the object would pass spontaneously through the gastrointestinal tract. No imaging was performed, and the patient was discharged without further follow-up. Upon presentation to our facility, a chest radiograph was obtained and revealed a single spherical foreign body lodged in the oesophagus. Based on these findings, the patient was prepared for urgent removal by oesophagoscopy. Intraoperatively, however, an additional foreign body was unexpectedly identified and successfully extracted from a location proximal to the object visualized on the chest X-ray. This finding highlighted the possibility of multiple foreign bodies despite imaging suggesting a solitary object. This case underscores the importance of maintaining a high index of suspicion in children with suggestive symptoms, obtaining appropriate imaging, and considering the possibility of multiple foreign body ingestion. Early referral and timely intervention remain crucial to reducing morbidity and improving outcomes in paediatric oesophageal foreign body cases.