Endoscopic removal of an embedded chicken bone in the esophagus: A case report

BACKGROUND

Sharp foreign body ingestion can cause gastrointestinal tract mucosa injury and requires proper endoscopic removal. Typically, protective devices are used to reduce mucosal damage. This case presents an alternative approach for the endoscopic removal of a large, irregular, and sharp foreign body (chicken bone) when traditional protective devices are inadequate, thus contributing to the management of such ingestions.

CASE SUMMARY

A 57-year-old male presented with a history of swallowing an irregular and sharp-pointed chicken bone. Emergent endoscopy showed it was tightly embedded in the esophageal wall, with minor bleeding. The chicken bone was grasped and moved cautiously using a foreign forceps. It was loosened after repeated attempts but could not pass through the pharynx. Considering possible mucosal damage, it was carefully pushed into the stomach cavity and then wrapped in a condom. The chicken bone was retrieved uneventfully by grasping the open edge of the condom with foreign forceps. No additional damage was found, except for primary esophageal injuries caused by the embedded chicken bone. The patient was discharged on the following day. Our experience demonstrated that condoms can be an alternative as a protective device under such conditions.

CONCLUSION

Condoms can serve as an alternative when traditional protective devices are unsuitable. Because of its smooth and oily nature, it can provide mucosal protection and lubrication during endoscopic removal.

Uncommon cause of chest pain: Case report of esophageal foreign body diagnosed by chest computed tomography scan

A 44-year-old man with a history of epilepsy presented with mild, persistent chest pain lasting 3 days, despite normal cardiac evaluations. A chest computed tomography scan revealed 3 artificial dental prostheses lodged in his esophagus, which the patient had inadvertently swallowed during a recent seizure. Endoscopic removal of the foreign bodies resolved his chest pain without complications. This case emphasizes the importance of considering esophageal foreign bodies as a differential diagnosis for persistent chest pain, particularly in patients with neurological conditions, and highlights the role of early imaging for accurate diagnosis and timely intervention.

Diagnostic and Management Value of Multi-Slice Computed Tomography in Esophageal Jujube Pit Impaction

Objective: The diagnostic value of multi-slice computed tomography (MSCT) in esophageal jujube pit impaction was explored in this study. Methods: A retrospective analysis was performed on MSCT data obtained from a cohort of 40 patients experiencing esophageal jujube pit impaction. The study period encompassed the interval from December 2018 to November 2019. The analysis involved examining the age distribution of the patients, the location of the jujube pit impaction, its connection to the esophagus, associated complications, and the methods used for treatment. All imaging results were compared with the outcomes of surgical or endoscopic interventions. Results: (1) Out of 40 patients, 30 individuals were 58 years old or above, constituting 75% of the study sample. (2) In 80% of the instances (32 cases), the jujube pit was located in the initial segment of the esophagus, exhibiting a spindle shape with varying levels of central low density. (3) We examined the correlation between the angle of the impacted jujube pit and the esophageal longitudinal axis, categorizing 2 cases as longitudinal impaction, 16 as oblique impaction, and 22 as transverse impaction. Among the 40 cases, 28 displayed only slight thickening of the esophageal wall at the impaction site, while 9 cases exhibited heightened periesophageal fat density, and 3 showed small periesophageal air bubbles. (4) Endoscopic evaluation identified damage to the esophageal mucosa in 35 instances and the formation of esophageal perforation in 5 cases. Among patients with perforation, one or both ends of the jujube pit had penetrated the esophageal wall, accompanied by different levels of surrounding inflammatory encapsulation. Conclusion: MSCT is crucial for pinpointing jujube pit impaction and its relation to the esophageal wall and nearby structures, aiding in preoperative and postoperative complications. It is highly feasible for endoscopic cases but limited in complex ones needing thoracoscopy or open-heart surgery.

Combination of gastroscopy and fibro‑bronchoscopy facilitates removal of incarcerated fish bone in the esophagus: A case report

Esophageal foreign body impaction is a notable clinical emergency. If the high-risk esophageal foreign bodies are not removed in time, life-threatening complications, such as perforation, infection and injury to the vessels, may occur. In the present study, the case of a patient experiencing a foreign body sensation in the throat after ingesting a fish bone by mistake is presented. A high risk of impending arterial puncture was confirmed using thoracic CT and thoracic aorta CT angiography scanning. The ends of the fish bone were first confirmed using a fibro-bronchoscopy light source passing through the bronchial and esophageal walls, before biopsy forceps were used to successively free the thoracic aorta and bronchial ends under gastroscopy. Finally, the fish bone was safely removed using a combination of gastroscopy and the rarely used fibro-bronchoscopy, and the patient recovered well after standard care. In certain cases of foreign bodies, it is necessary to use multiple strategies in a timely manner according to the type and location of the ingested foreign body.

Accidental Sewing Pin Ingestion by a Tailor: A Case Report and Literature Review

Foreign body ingestion is a frequently encountered emergency in healthcare institutions. It mostly affects pediatric populations, although it can also affect adults with developmental delays, those with psychiatric diseases, drug abusers, and prisoners. Endoscopy is a diagnostic and treatment method for suspected foreign body ingestion. In this article, we discuss a 45-year-old tailor who swallowed a sewing pin while at work. The abdominal X-ray showed a needle-shaped metal shadow in the stomach region. During an upper endoscopy, it was discovered that a sewing pin with a sharp edge was stuck in the pylorus. The sewing pin was extracted endoscopically, and the patient was discharged the same day in good condition. Since the estimated risk of complications of foreign body ingestion in the adult population is about 35%, and the most common complications include impaction, laceration, bleeding, or perforation of the gastrointestinal wall, endoscopic or surgical removal is necessary. This also emphasizes the importance of a careful endoscopic evaluation of some at-risk occupations for foreign body ingestion with or without gastrointestinal complaints.

Management of oesophageal foreign bodies in children: a 10-year retrospective analysis from a tertiary care center

OBJECTIVE

Oesophageal foreign bodies (EFBs) are a common emergency issue in paediatrics, and few studies have revealed its clinical features and treatment methods. We conducted this retrospective study to provide our 10-year clinical evidence for the diagnosis and treatment of EFB and reduce the incidence of complications.

METHODS

We retrospectively reviewed all paediatric cases diagnosed with EFB from January 2012 to December 2021 at Shenzhen Children's Hospital. The age and sex of the patients, types of foreign bodies (FBs), preoperative examination, location and duration of FB impaction, clinical symptoms, surgical methods, therapeutic effects and complications were analysed.

RESULTS

Among the 1355 cases, 759 were boys and 596 were girls, with a median age of 2.9 years (4 months to 16 years). The shortest FB lodged time was 1 hour, while the longest time was 3 months. The types of foreign bodies included coins and blunt objects (812,59.9%), bones and sharp objects (278,20.5%), button batteries (86,6.3%), food impactions (84,6.2%), toys (51,3.8%) and plastic objects (44,3.2%). A total of 720 of 812 cases impacted by coins and blunt subjects were successfully treated with a Foley catheter without any complications. A total of 558 patients underwent rigid oesophageal endoscopy under general anaesthesia, and foreign bodies were successfully removed in 525 cases. No FB was found in 33 cases, and FBs pushed into the lower digestive tract during operation in 5 cases. Oesophageal injury was found in 130 cases (23.3%). Our study showed that the age of the patient, time of foreign body incarceration, type of foreign body, location of the lodged foreign body, and fever or cough were risk factors leading to oesophageal foreign body complications, and the differences were statistically significant (P < 0.05).

CONCLUSION

Children with EFB have a risk of complications, especially if the FB is a button battery. The appropriate surgical method should be selected through the analysis of the clinical characteristics of the foreign body in the oesophagus and the risk factors for complications to reduce the incidence of complications. Health education and effective care are the keys to the prevention of EFB.

Fish Hook as Foreign Body: Not All Foreign Bodies Can Be Fished Out of the Esophagus With Endoscopy Alone

A 75-year-old male presented to the hospital with acute onset of neck pain. Although the patient did not report known ingestion of a foreign body, there was evidence of a fish hook in the cervical esophagus on plain neck radiography. Due to the location at the upper esophageal sphincter in the hypopharynx, the foreign body was not retrievable by endoscopy alone and required better visualization and airway protection with direct laryngoscopy and rigid esophagoscopy. A fish hook was promptly retrieved within 24 hours of the patient's presentation and his symptoms resolved without complications. We report this unusual case to emphasize the importance of proper food preparation, thoroughly chewing food before swallowing, and prompt management of foreign body ingestion in adults.

Concealed Foreign Body Shrouding Airway Mimicking Mass Causing Extubation Failure, Hypoxia, and Stridor

Foreign body (FB) aspiration can present with acute life-threatening asphyxiation to recurrent infections with lung damage. Although most esophageal FBs pass spontaneously, sharp ones can get embedded requiring treatment. Tracheobronchial FBs and hypopharyngeal FBs are occasionally seen as well. We present a case of an oropharyngeal FB presenting with signs of stroke, pulmonary embolism, pulseless, and causing airway compression and extubation failure. Old age and neurocognitive disability are important predisposing factors of FB airway obstruction (FBAO), with food being the most common cause. The classic triad of cough, dyspnea, and cyanosis is seen in only a small percentage of patients with FBAO. Laryngeal edema, soft tissue collapse, and laryngospasm are among the common causes of upper airway obstruction and extubation failure. Laryngeal traumatism that can occur during emergency intubations can cause post-extubation stridor that can be treated with corticosteroids. Dentures and blood have been reported to cause post-extubation complications but oropharyngeal FB causing airway compression and leading to extubation failure has not been reported before. We recommend FB to be considered in the differential diagnosis of immediate hypoxia and extubation failure regardless of the history of a witnessed aspiration event as it is an easily fixable cause and can be missed in the initial history of presentation. A high degree of suspicion for this should be maintained as it is easy to miss. Computed tomography of the neck can aid in the diagnosis.

Clinical outcomes of endoscopic removal of foreign bodies from the upper gastrointestinal tract

Background

Ingested foreign objects frequently require emergency removal. This study aimed to investigate the clinical outcomes of endoscopic removal of foreign bodies from the upper gastrointestinal tract and the risk factors for adverse events.

Methods

Adults (> 18 years) who underwent endoscopic management of ingested foreign bodies at two centers, one inland and one on the coast, between January 2008 and December 2017 were eligible. Clinical characteristics and procedure-related outcomes were retrospectively reviewed. Patients were divided into two groups, based on whether the foreign bodies were sharp or blunt in shape.

Results

A total of 853 patients aged 19–96 years were analyzed. Ingestion of fish bones was more common in the coastal area, whereas ingestion of food boluses was more common in the inland area. The duration of impaction ranged from 1 h to over 1 month and was significantly longer in patients who ingested blunt than sharp foreign bodies (15 vs. 5 h, p < 0.001). Most (98.9%) foreign bodies were successfully removed. Adverse events occurred in 31.2 % of patients, including ulcers (4.0%) and perforations (3.3 %). Multivariate analysis showed that age (odds ratio [OR] 1.015, p = 0.012), sharp foreign bodies (OR 5.133, p < 0.001), location in the esophagus (OR 2.723, p = 0.018), and duration of impaction (OR 1.431, p < 0.001) were factors associated with adverse events.

Conclusions

Early recognition and timely endoscopic removal of ingested foreign bodies, particularly in elderly patients and those with sharp foreign bodies, may improve clinical outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12876-021-01959-3.

Swallowed partial denture in severe intellectual disability patient

Swallowed partial dentures in elderly patients is an emergency situation that requires a swift response. Here, we report a case involving a patient with severe intellectual disability who swallowed his denture, which lodged at the oesophagus inlet. After failure of endoscopic removal, denture with clasp was removed using long forceps through intraoral approach under intravenous sedation. At the pharynx and oesophagus inlet level, removal of foreign body via intraoral approach should be preferentially considered over open surgery for faster patient recovery.

[Diagnostic and treatment of foreign bodies of the upper digestive tract]

OBJECTIVE

To evaluate the results of diagnosis and treatment of foreign bodies of the upper gastrointestinal tract.

MATERIAL AND METHODS

There were 1187 patients aged 15-99 years with suspected foreign body of the upper gastrointestinal tract. In 536 patients (266 men, 270 women), foreign bodies were detected. Ingestion of a foreign body was more common in patients aged 46-65 years. In 516 patients, foreign bodies were detected in the esophagus (pharyngo-esophageal junction - 25, upper third of the esophagus - 426, middle third of the esophagus - 34, lower third of the esophagus - 21, esophageal-gastric junction - 10). Four patients admitted with esophageal wall perforation. In 3 cases, foreign bodies were localized in the throat, 15 patients - in the stomach, 2 patients - in the duodenum.

RESULTS

In most cases, foreign bodies were organic (n=506). Removal was successful in 530 cases. In 4 patients with esophageal wall perforation and mediastinitis, removal was performed intraoperatively. Flexible endoscope was used in 500 cases. In 86 patients, foreign bode was displaced in the stomach using flexible endoscopy. Foreign body removing wasn't successful in 4 cases. In 2 patients, extraction was followed by esophageal wall damage. In 4 patients, esophagotomy was applied to extract foreign body. Suturing the esophageal wall defect was carried out in 2 cases. Abrasion and erosive esophagitis were the most common injuries of esophageal mucosa. Esophageal diseases were detected in 75 cases after foreign body removal (67 cases - benign esophageal diseases). One patient died from bedsore of innominate artery complicated by acute hemorrhage.

CONCLUSION

Foreign bodies of the upper gastrointestinal tract are observed in 45% of patients at admission. Neck and chest X-ray examination is obligatory before endoscopy. Flexible endoscopy is a gold standard for diagnosis and extraction of foreign bodies. Repeated endoscopy after foreign body extraction should be mandatory. It is necessary to visualize complications associated with foreign body and identify esophageal diseases.

Foreign body esophagus: Six years of silence

Foreign body esophagus remains one of the common medical emergencies which may lead to significant morbidity and mortality. Sharp objects, batteries, and elderly with foreign body esophagus should be treated with emergent removal owing to the complications that might ensue. Endoscopic removal is the preferred choice of treatment but for large foreign body, sharp foreign body, and so on, rigid esophagoscopic removal might be more preferable. Foreign body esophagus though an obvious situation might at times be missed. It is important to make an early definitive diagnosis. We report a unique case of missed foreign body (denture) esophagus despite the obvious signs and symptoms. Definitive diagnosis was made only after 6 years due to the lack of definitive diagnostic procedures and expertise. The foreign body was impacted in the mucosal wall of the esophagus requiring Gastric resection and anastomosis (with McKeown procedure). With this we have tried to highlight the pitfalls in the diagnosis and management of foreign body esophagus. We report a case of a 55-year-old female who presented to the Emergency Room with history of progressive dysphagia and odynophagia for 6 years which was aggravated for the past 6 months. A radiological diagnosis was made. It was followed by a failed attempt of endoscopic removal which warranted the surgical removal of the foreign body.