A unique approach to foreign body retrieval

Abstract

Clinical Presentation: A 46 year old morbidly obese male presented to the emergency room with acute onset of dysphagia to solid food after having lunch. Patient was only able to swallow small quantity of liquid. Patient denied excessive salivation, nausea, vomiting, hematemesis, abdominal pain or chest pain. Past medical history was significant for recent laparoscopic band ligation for weight reduction. There was no previous history of achalasia or reflux symptoms. He was not taking any medications. He was neither an alcoholic nor a smoker. Physical exam revealed a morbidly obese male in no acute distress. Endoscopic examination was performed which revealed mildly dilated esophagus with moderate amount of saliva. A grape was noted in the distal esophagus. It appeared to cause intermittent distal esophageal obstruction. Attempts at pushing the grape through the lower esophageal sphincter (LES) with the scope were hampered by the slithering of the grape along the side of the scope. Attempts to grasp the grape with tripod forceps were unsuccessful due to slippery surface of the grape. A unique approach was adopted to retrieve the grape. An esophageal band ligator was applied to the tip of the scope. The grape was suctioned and anchored into the barrel and removed successfully.