1812 Upper Esophageal Stenosis Secondary to Multiple Foreign Body Ingestions

Abstract

INTRODUCTION: Multiple episodes of foreign bodies ingestion and subsequent esophagogastroduodenoscopies (EGDs) can lead to an uncommon and disabling complication- esophageal stenosis. We present an interesting case of recurrent foreign body ingestions complicated by upper esophageal stenosis making further foreign body retrieval difficult. CASE DESCRIPTION/METHODS: A 33-year-old female with a past medical history of borderline personality disorder, impulse control disorder and recurrent non-suicidal foreign body ingestions requiring multiple EGDs and surgeries presents to the emergency department after ingesting a battery. On arrival, she complained of trouble swallowing, chest pain and abdominal pain. Physical examination was remarkable for abdominal tenderness and guarding. Laboratory results showed hemoglobin of 8.4 gm/dl and hematocrit of 27.8%. Plain radiography of the chest and abdomen revealed a radiopaque tubular device overlying the stomach (Figure 1a) and a cylindrical radiopaque foreign body overlying the left upper quadrant over the stomach (Figure 1b), respectively. Patient was intubated and scheduled for an EGD. During the procedure, the patient was noted to have scarring and granulation polyp in the mid esophagus. (Figure 2) A battery was found in the gastric body and removed via a snare. During retrieval, the cricopharyngeus muscles were found to be tight and did not enable the passage of the battery. That required the use of Miller blade to open up the pharynx to enable safe passage. Battery was intact on removal. (Figure 3) The patient tolerated the procedure well and was discharged home after a period of observation. DISCUSSION: Foreign body ingestion and subsequent endoscopic procedures are associated with a variety of complications, including perforation, bleeding and infection. Those complications may result from the sedation as well as the diagnostic and therapeutic maneuvers performed. Our patient had a history of multiple foreign body ingestions, including knives and razor blades, requiring multiple EGDs for their removal. These together led to scarring of her esophagus with subsequent healing and contraction, resulting in esophageal stenosis. This warranted additional intervention and multidisciplinary approach for safe removal of the foreign body. Given the risk of esophageal stenosis in patient with recurrent foreign body ingestions, endoscopists should keep this complication in mind and be prepared with the needed equipment.