Knife swallowing ended up with esophagectomy

Abstract

A 30-years-old male was admitted to surgical emergency department with three-day history of shortness of breath and chest discomfort. He looked healthy, but confused. According to the patient`s statement, he did not have any cronicalillneses or operation, and his medical history was ordinary. His parents told us that his behaviour changed in the last few weeks. He was afebrile with normal vitals, and no associated nausea, vomiting, or fever was present. Lung auscultation showed normal results. After the initial assessment, a chest X-ray was performed (Figure 1), which revealed large, stright edge kitchen knife in the oesophagus. After being presented with a chest X-ray, the patient showed no knowledge, or any memory whatsoever, of swallowing the knife, and even looked a bit surprised. He had firmly refused proposed endoscopic examination, initially offered by a physician. Abdominal CT showed the same, without any evidence of pneumothorax,  pneumomediastinum or pneumoperitoneum (Figure 2). After the initial assessment, and due to the size and position of the knife, it was estimated that endoscopic removal would be too risky, and was therefore decided that it would have been in the best interest of the patient to undergo surgical extraction by esophagectomy (Figures 3 and 4), and three months later esophageal reconstruction with colonic interposition.