Esophageal Food Disimpaction: But Doc, I Still Feel a Bone Stuck in My Throat

Abstract

Purpose: Esophageal food impaction is a distressing condition requiring urgent endoscopic intervention. Meat with or without a sliver of bone seems to be the most common offending agent. It is not uncommon for patients to have persistent discomfort and a foreign body sensation in the throat despite disimpaction. It is usually accounted for trauma pertaining to the length of time the bolus was lodged and the characteristics of the food bolus itself. Therapeutic endoscopic intervention itself may result in trauma also. It is usually treated conservatively with throat lozenges or other topical therapies and usually improves with time. A 45 year old male presented to the local community hospital with a food impaction 12 hours after ingesting boneless grilled pork-chops. Although overnight, the food bolus seemed to have passed; he still continued to have a foreign body sensation in his throat as if a bone was stuck even though he ate boneless pork-chops. Urgent endoscopy revealed no evidence of food bolus but patches of erythema in the oropharynx, epiglottis and the cricopharyngeus. No strictures or webs were encountered. Careful evaluation of the area revealed a 2 cm long thin metal wire lodged behind the epiglottis. This was removed with a biopsy forceps with significant technical difficulty. It was later determined that this represented a piece of the wire brush that was used to clean the grill. This wire must have adhered to the boneless meat that was grilled. Conclusion: 1. The presence of a persistent foreign body sensation despite disimpaction of the meat bolus makes it imperative for the endoscopist to spend extra time to look for any other foreign objects which may have potential serious consequences, in this case a piece of metal wire. 2. Consideration should be given to soft tissue x-rays of the neck to look for any metal or opaque objects if endoscopy is unrevealing.