A rare esophageal foreign body found in a patient with mental retardation: safety needle

Impacted sharp foreign bodies in the esophagus can be very difficult to manage. When attempts are made to remove such objects inappropriately, life-threatening complications such as perforation can occur. The aim of this study was to evaluate the safety and efficacy of endoscopic removal of impacted sharp foreign bodies in the esophagus using proximal dilatation with an oral side balloon or transparent cap. A total of 22 patients (10 men, 12 women) with impacted sharp foreign bodies in the esophagus underwent endoscopic extraction. The following technique was successfully performed at our hospital. An oral side balloon (Top Co., Japan) for esophageal variceal sclerotherapy was attached to the distal part of the endoscope. With the patient under local anesthesia, the endoscope was inserted as far as the proximal part of the esophageal foreign body. The oral side balloon was then gradually inflated. Dilatation of the proximal part of the esophagus made it possible to release the impacted sharp foreign body from the esophageal wall. A transparent cap was used for foreign bodies in the upper esophagus when there were difficulties with the oral side balloon. The types of foreign body removed were fish bones (n = 9), press-through packages (n = 8), chicken bones (n =3), dentures (n = 1), and a wrist watch (n = 1). Endoscopic removal was successful in all but one of the cases, in which a fish bone had to be extracted surgically. The proximal dilatation method using an oral side balloon or transparent cap is safe and effective in removing sharp foreign bodies from the esophagus, avoiding surgery and possible perforation.

Introduction:The typical manifestations of patients with a trisomy 21 syndrome are mental retardation and anatomical deformities of face and neck. In the available literature, all case reports regarding anesthetic management of mentally retarded patients have focused on elective surgeries. There is no report regarding anesthetic management of mentally retarded patients undergoing emergency surgery.Patient concerns:A 47-year-old woman with a mental retardation grade 2 by trisomy 21 syndrome suffered from an esophageal foreign body for 3 days and needed emergency removal of esophageal foreign body. The patient had a poor cooperation and obvious anatomical abnormalities of head and neck.Diagnoses:Difficult anesthesia and airway managements for emergency removal of esophageal foreign bodies in a trisomy 21patients with mental retardation and predicted difficult airways.Interventions:Combined use of an intubating supraglottic airway and the flexible bronchoscope-guided intubation after intravenous anesthesia induction.Outcomes:Effective airway was safely established and an esophageal foreign body was successfully removed by rigid esophagoscopy under anesthesia. The patient recovered smoothly without any complication.Lessons subsections as per style:When general anesthesia and emergency airway management are required in the patients with mental retardation and predicted difficult airways, a combination of the supraglottic airway and the flexible bronchoscope maybe a safe and useful choice for airway control.

BackgroundForeign body in the esophagus is most commonly observed at the cervical esophagus level and is often detected in pediatric patients. Esophagoscopy is the definitive diagnosis and treatment instrument in foreign body ingestion, and the procedure should not be delayed to avoid serious complications such as late tracheoesophageal fistula and perforation. While sore throat, difficulty in swallowing, and hypersalivation are the main complaints in almost all patients, respiratory symptoms due to tracheal compression can also be observed.Case presentationWe present our 5-year-old patient who presented with the complaint of foreign body ingestion, dysphagia, and hypersalivation due to foreign body in the cervical esophagus, and isolated central awake apnea, which is not seen in the literature. The patient, who had central awake apnea in the supine position, was completely normal after the removal of the foreign body.ConclusionsForeign bodies in the esophagus, which are not more urgent than foreign bodies in the respiratory tract, can sometimes threaten life through central apnea in the acute process, and one should be alert.

Rationale:The ingestion of a foreign body (FB) with complete impaction of the esophagus is not common. Here we report a rare case of successful retrieval of a spherical stone in the esophagus of a man with mental retardation, using gallbladder grasping forceps and rigid endoscope.Patient concerns:A mental retarded man came to the emergency department presenting with recurrent nausea, vomiting, and dysphagia after swallowing a spherical stone. He had previously undergone an FB extraction under general anesthesia by fiberoptic esophagoscopy, which failed.Diagnosis:The diagnosis of FB ingestion was confirmed by anteroposterior plain film x-ray of the chest and chest computed tomography (CT), which showed the ingested spherical FB in the upper esophagus.Interventions:After multiple failed attempts using other instruments, the FB was successfully removed with gallbladder grasping forceps through a rigid esophagoscope.Outcomes:The patient was discharged without any complications. The nasogastric tube was extubated at the 10-day follow-up.Lessons subsections as per style:For esophageal retrieval of uncommon FBs, the instrument used is crucial. We report our experience retrieving a large and spherical FB in the upper esophagus using gallbladder grasping forceps. This proved to be an effective strategy, eliminating the need for thoracotomy.

Introduction. Infants learn the world while playing through the taste of objects. If the parents neglect it, the object in the mouth can be swallowed. Foreign bodies in the esophagus are easily diagnosed, as a rule, since immediately after getting stuck they are manifested by salivation, choking, difficulty in passing food. If a foreign body passed into the esophagus being unnoticed, in 20% various complications develop, such as esophagitis, stenosis, organ perforation, esophageal-tracheobronchial fistula, mediastinitis, aortoesophageal fistula, cervical spondylitis.Material and methods. The article presents a clinical case of the long time presence of a large foreign body in the esophagus of an infant which was simulating respiratory disorders. The child was admitted to a surgical hospital with suspected congenital tracheoesophageal fistula because when swallowing liquid food he did not manifested any complaints typical for foreign bodies in the esophagus: pain in the neck and sternum with irradiation to the interscapular region, difficulty or inability to swallow, urge to vomit, hypersalivation. Mom and doctors were inclined to find other reasons for cough and wheezing which were intensified when the child was eating. The authors discuss features of extraesophageal manifestations of a foreign body in the esophagus as well as diagnostic and therapeutic tactics in such cases.Conclusion. Even small children can swallow large foreign bodies. While taking anamnesis, especially in children of the first year of life, a doctor should think not only about the syndrome of bronchial obstruction, but also about possible presence of a foreign body in the esophagus if wheezing and coughing attacks appear during meal. Diagnostic algorithm should include X-ray and endoscopic examinations which are effective and minimally invasive and which allow to remove a foreign body, even if it is in the esophagus for a long time.

Statistical observation on the cases of foreign bodies handled in our clinic during the period from 1956 through 1965 was performed.The results were as follows.1. 1, 043 cases (approximately 1%) out of 108, 760 patients treated in our ear, nose and throat clinic during last 10 years, were recognized as the foreign bodies.2. The locations of the foreign bodies were as follows: 507 cases in esophagus (50% of all foreign bodies), 177 cases in pharynx (17%), 170 cases in gastrointestinal tracts (16%), 63 cases in larynx, trachea and bronchus (6%), 87 cases in ear (8%), 41 cases in nose (4%) and 2 cases in maxillary sinus.3, More than 50% of the foreign bodies were found in infants and were found to be coins in esophagus.It is important to discuss about the cases of coins in esophagus as well as beans in bronchus of the infants.4. 365 cases (72%) of 507 cases in esophagus were coins which were lodged at the entrance of esophagus. Fish bones, artificial dentures and pieces of meat were seen in the second strictures as much as in the first strictures.124 (90%) of 138 foreign bodies found in mesopharynx were fish bones and more than 50% of them were found within the palatine tonsil.Foreign bodies in bronchus were seen in 48 cases, which were almost lodged at the area of carina.Insects were most common among the foreign bodies of ear canals and often cause otitis media.5. The removal of foreign bodies in about 75% of total cases was performed by means of Endoscopy. Foreign bodies were removed via the external esophagotomy approach in 5 cases and via the tracheotomy approach in 13 cases.6. The complications of foreign bodies in esophagus were periesophageal abscess in 6 cases and in death in 2 cases. Especially in infant, there were 11 cases diagnosed as other respiratory diseases than foreign bodies by the pediatrist and 3 cases suffocated to death. The foreign bodies in these cases were found by the bronchoesopha-gologist.7. The authors reported the statistics of foreign bodies, treated in our clinic during the period of 1936-1965.

Introduction: Current ASGE guidelines recommend emergent removal of esophageal food bolus impactions and foreign bodies though this is two star (low quality evidence) guideline and further research has been recommended in this area. We aim to study the differences in outcomes based on early versus late esophagogastroduodenoscopy (EGD) among patients presenting with a foreign body in esophagus using a large national inpatient sample database. Methods: The National Inpatient Sample (NIS) databases (2002-2011) is the largest all payer inpatient care database, containing around 5 to 8 million hospitalizations from approximately 1000 hospitals in the USA. The patients presented with foreign body in esophagus and EGDs were identified using the ICD-9 codes. Early EGD was defined as being performed on the day of admission. Various outcomes such as inpatient mortality, acute respiratory failure (ARF)/aspiration pneumonia (AP), iatrogenic pneumothorax, endotracheal intubation, length of stay (LOS), and total hospitalization cost were evaluated. Multivariate logistic regression analysis adjusted for age, sex, race, complications and Elixhauser comorbidities was used to identify independent predictors of inpatient mortality. Results: Our study included 21,475 hospitalizations related to a foreign body in esophagus. The mean age of the study population was 51.2 years with 71.8% white and 54.9% male. Overall 55.8% of hospitalizations had an early EGD. There was a significantly lower rate of ARF and AP requiring endotracheal intubation >96 hours among hospitalizations with early EGD (ARF/AP: 9.2% vs 12.6%, p < .001; intubation: 0.7% vs 1.3%, p < .001). Hospitalizations with early EGD had a significantly lower rate of inpatient mortality. (0.6% vs 1.9%, p < .001). Multivariate logistic model identified age, delay in EGD, requiring endotracheal intubation, ARF/AP and having multiple comorbid conditions as independent risk factors associated with inpatient mortality (Table 1). Overall hospitalization mean LOS and financial charges were significantly lower among hospitalizations with early EGD. (LOS: 2.0 vs 4.2 days, p < .001; financial cost: $16,634 vs $24,390, p < .001).Table 1: Independent risk factors associated with inpatient mortality among hospitalizations with foreign body in esophagusConclusion: Our study showed significantly reduced finalcial burden, and lower rates of complications and inpatient mortality related to foreign body in esophagus among individuals who undergo early EGD. Our study adds high quality evidence to current ASGE guideline by utilizing a large nationally representative hospitalization sample.

Foreign body ingestion is a common emergency situation in children with one or a few objects having been ingested. Here we report our experience using endoscopic retrieval in a female centenarian with dyspnea and foreign bodies in the esophagus. She attempted suicide by swallowing 26 coins and two other foreign bodies. A gastroscope was used to remove all foreign bodies in the lower esophagus. In total, 26 coins, one ferrous ring and one cylindrical plastic object were retrieved. To our knowledge, this is the first clinical report on retrieval of so many foreign bodies in a single case.

Analysis of Risk Factors of Esophageal Perforation in Patients with Esophageal Foreign Bodies

Introduction: Ingestion of foreign bodies is common and the esophagus is the most common site of impaction in the upper gastrointestinal tract. Case Series: We report two cases of impacted metallic foreign bodies in upper esophagus. The presentating symptoms were throat pain and dysphagia. Rigid and flexible esophagoscopy failed to retrieve the foreign body in both cases hence lateral cervical esophagostomy was performed for foreign body removal. Conclusion: Ingestion of foreign bodies is common. Some metallic foreign bodies frequently get impacted in the esophagus because of their large size, rigidity and pointed edges and are difficult to remove by endoscopy. Therefore, surgery is required for retrieval of such impacted, sharp, metallic foreign bodies.

Summary Foreign bodies in esophagus are avoidable accidents that occur most often in children younger than 3 years. The most common presenting symptoms are dysphagia, drooling, and vomiting. Revelation by respiratory distress is a rare and unusual condition. Objective We describe and discuss the case of an esophageal foreign body, in which the patient presented with respiratory distress. Case report A two-year-old child was admitted to the emergency department for acute respiratory distress. He had no history of choking episodes or dysphagia. Nevertheless, he was brought by his parents several times for a persistent cough and wheezing that was treated as asthma for a month. Pulmonary examination had revealed polypnea, suprasternal recession, scattered snoring, and diffuse wheeze. As part of his assessment, a chest X-ray was demanded. It had shown, as unexpected, a nonmetallic foreign body in the upper thoracic esophagus. A clothing button was removed by hypopharyngoscopy under sedation without any incident. Subsequent follow-up had not shown any complications related to this episode. Conclusion Large esophageal foreign bodies can impinge on the trachea causing upper respiratory tract signs. We alert clinicians on variation in the presentation of foreign body ingestion, and we emphasize the importance of an early diagnosis and management.

Introduction. Sharp, retained foreign bodies in the oesophagus are associated with severe complications. Developmentally delayed patients are especially subject to foreign objects. We describe a 37-year-old, developmentally delayed male with a mincer blade obstructing the oesophagus. Six months prior to surgical intervention, the patient was hospitalized in a condition of sepsis and pneumonia where the thoracic X-ray reveals a foreign body in the proximal oesophagus. When rehospitalized 6 months later, a mincer blade of the type used in immersion blenders was surgically removed. During these 6 months the patient's main symptoms were dysphagia, weight loss, and diarrhoea. When developmentally delayed patients present with dysphagia, we strongly encourage the awareness of the possible presence of foreign bodies. To our knowledge this is the first reported case of a mincer blade in the oesophagus.

Introduction: A Foreign body ingestion and ofreign body aspiration commonly affect children between 6 months and 6 years. Items that are commonly swallowed by children are small and shiny object, such button batteries and magnets that have increased rapidly over the last decade. Botton battery ingestion an established surgical emergency, requiring immediate removal. Delay in diagnosis can lead possible complication such as inflammation, necrosis of esophageal mucosa and esophageal perforation. Rigid esophagoscopy is mainstay procedure of management foreign body in esophagus. Case Report: A case of foreign body battery in esophagus was reported in a 4 year old girl with chief complain felt something stuck at the throat since 3 days before admission and patient performed thoracal x-ray. Esophagoscopy was performed to remove battery foreign body in esophagus. At the time of evaluation, necrosis and excoriation was found in the esophagus as high as 18 cm from the incisivus. Conclusions: Delay in diagnosis and management of foreign battery in the esophagus could lead in to severe clinical manifestations and could cause the complication. Esophagoscopy remains the mainstay management of foreign body in esophagus because of its good visualization.

Swallowed Foreign Bodies in Children: Aspects of Management

Purpose Foreign body ingestion is a common cause for children to visit the emergency department. Removal of esophageal foreign body was usually done by an endoscopy. After Bigler introduced the Foley catheter technique for esophageal foreign body in 1966, many studies were performed regarding such technique. However, only a few researchers in Korea have attempted to report this technique. This study reports a 10-year experience of the Foley catheter removal method for blunt esophageal foreign body at a single center in Korea. Methods Medical records of patients who were treated as esophageal foreign body with Foley catheters between March 2005 and February 2015 were retrospectively reviewed. Their clinical characteristics and outcomes were evaluated. Results A total of 73 patients were treated as esophageal foreign body impaction using the Foley catheter method. Foreign body removals were successful in 67 (91.8%) cases. Six failed cases were treated with esophagoscopy or endoscopy. The mean age was 3.7 years old. The most common foreign body was a coin (80.8%). Foreign bodies were lodged at the upper esophagus level most frequently (79.5%), followed by the middle esophagus (12.3%) and the lower esophagus (6.8%). During the removal procedure, 43.8% of patients were sedated, and 95.9% were treated with fluoroscopy. There were no positive correlations between the removal success and sedation (P=0.54) or using a fluoroscopy (P=0.23). In 69 cases (94.5%), there were no serious complications. However, in one patient, complications, such as vomiting, fever, and esophageal ulceration were observed. One patient complained fever and esophageal ulceration. In 3 (60%) of the total 5 patients with button battery ingestion, serious complications, such as fever or esophageal ulceration, occurred. Conclusion Removal of blunt esophageal foreign body using a Foley catheter in children is a useful and relatively safe method. However, patients with button battery ingestion need more attention when trying the Foley catheter removal technique. Key Words: Foreign Bodies; Esophagus; Urinary Catheters