A missed giant rhinolith retained for a decade in a paediatric patient at a zonal referral hospital in Central Tanzania: Case report and literature review

Abstract

Introduction and importance: Rhinolith is an entity formed by gradual deposition and coating of different salts of calcium and magnesium over an endogenous or exogenous nidus in the nasal cavity. The type, size and duration of the rhinolith lead to multiple types of presentation. Giant rhinoliths are very rare in paediatric patients owing the size of their nasal cavities. To the best of our knowledge this is the first reported case of a giant paediatric rhinolith in Tanzania.

Case presentation: We present a 12-year old male who presented with a history of left sided nasal obstruction accompanied with foul smelling nasal discharge for 11 years and was marked by being followed by house flies. Had history of occasional episodes of headache but no facial pain. He was managed at various remote health facilities without specialist consultation for eleven years as case of allergic rhinitis and rhinosinusitis and finally was referred with a provisional diagnosis of chronic granulomatous disease of the nose. The patient underwent anterior rhinoscopy and a left sided stony hard mass was removed under topical local anaesthesia.

Clinical discussion: The patient underwent anterior rhinoscopy and a left sided stony hard mass was removed under topical local anaesthesia. Postoperatively he was kept on a nasal decongestant, a broad-spectrum antibiotic and an analgesic.

Conclusion: Any child with unilateral foul smelling nasal discharge should be considered to have a nasal foreign body until proven otherwise. The treatment of choice remains to be nasal foreign body removal under local or general anaesthesia.

Keywords: Giant; Missed; Paediatric patient; Rhinolith; Tanzania.