In response to wire grill brush bristle as an unusual foreign body: Report of two pediatric cases.

We are truly grateful to Dr. Flis and colleagues for sharing their experience treating adult and pediatric patients who have experienced accidental ingestion of wire grill brush bristles. Although we report an additional two adult patients who were treated for the same problem during the past 12 months, none of our patients had bowel perforations by these unassuming and miniscule foreign bodies. Due to their metallic and sharp nature, bowel perforation injuries are not surprising. Dr. Flis’ reports of specific cases resulting in perforated jejunum and hepatic abscess highlights the potential for significant morbidity due to this injury. It is difficult to appreciate the true incidence and prevalence of this injury unless efforts are made to survey more otolaryngologists and even emergency department physicians. Throat pain, odynophagia, and globus sensation appear to be the most common presenting symptoms of wire brush bristle ingestion. For acute onset odynophagia and/or globus sensation, it is particularly important to ask about history of recent ingestion of grilled foods. A positive history should increase the suspicion of wire grill brush bristle ingestion as a differential diagnosis. This information should be shared with colleagues in both adult and pediatric subspecialties such as emergency medicine, gastroenterology, surgery, and even fellow otolaryngologists. We have learned that wire grill brush bristles may be missed on physical exam, flexible laryngoscopy, plain radiographs, and even esophagrams, which then results in delay in diagnosis and even dismissal from the emergency room. Serious complications are most likely avoidable through product improvement, public and physician awareness, and timely diagnosis with subsequent removal. Manufacturers of wire grill brushes are unlikely to add a warning label unless pressured to do so from the US Consumer Product Safety Commission. I have discarded all wire grill brushes at home and insist that my husband (our grill master) only use a cleaning stone. When eating out, we do try and remember to inspect our food and that of our 6-year-old, but it is difficult to consistently do so. Perhaps additional spotlights in mainstream media of this potential injury would increase public awareness.