A Christmas message: be careful of the confetti stars

To the Editor: Christmas is known for festive decorations. Many a table will be laced with confetti stars and other paraphernalia this season. We believe the potential dangers associated with ingestion of these particular foreign bodies deserve attention.

A 9‐month‐old girl presented to hospital after a choking episode in which her mother noted some blood streaking in the child's saliva. No features of the history suggested foreign body inhalation. Physical examination was unremarkable, and she was discharged as having choked on her own saliva.

The girl returned 2 days later with increased work of breathing, fevers, cough and reduced oral intake. Examination revealed a respiratory rate of 68 breaths per minute, erythematous throat, and intermittent wheeze. She was diagnosed with bronchiolitis and received inpatient treatment for 3 days.

Fevers, persistent cough and marked reduction in oral intake ensued. She re‐presented 6 days later with worsening lethargy, left neck mass, and drooling. Examination revealed pyrexia (39.4°C), normotension (106/70 mmHg), tachypnoea, peripheral hypoperfusion, erythematous throat and a large left submandibular mass. She was diagnosed with a viral upper respiratory tract infection with possible lymphadenitis.

Ultrasound was performed, with appearances suggestive of abscess. Subsequent computed tomography of the neck demonstrated a large retropharyngeal abscess markedly narrowing the airways. In addition, a star‐shaped density was discovered at the margin of the abscess (Box). During emergency incision and drainage in theatre, a plastic star embedded within the posterior hypopharyngeal wall was removed. Discharge occurred after 5 days of intravenous antibiotics. No complications have been recorded to date.

Despite their flexible nature, the sharp points of confetti stars appear to increase the risk of lodgement in the upper aerodigestive tract, and their reflective surfaces attract the interests of young children with a propensity to place things in their mouths. While uncommon, the potential for similar cases to present over these Christmas holidays exists. Wider dissemination of these illustrative cases to primary care physicians and the public as well as a review of warning labels on these decorations may be prudent.

Box – Coronal computed tomography (CT) neck scan (A) and sagittal CT neck scan (B) showing the size of the abscess. CT reconstruction with the ingested star clearly outlined beside the abscess with overlying nasogastric tube (C). Confetti star of the same make that was found during surgery* (D)

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*Open‐source image.