S2087 Endoscopic Cap-Assisted Retrieval of a Fishbone in the Esophagus

Abstract

INTRODUCTION: Foreign body ingestion is a common cause of dysphagia and odynophagia. Common presenting symptoms can include dysphagia and odynophagia as previously mentioned, as well as chest pain/pressure, globus sensation, nausea, vomiting, or neck pain. While the majority of foreign bodies will pass spontaneously, a subset can become stuck and require retrieval. Cap-assisted endoscopic retrieval can aid in removal of the foreign body. We present a case of a patient who presented with odynophagia and globus sensation found to have a fishbone in his esophagus after eating fish for dinner. CASE DESCRIPTION/METHODS: The patient is a 62 year old male without significant past medical history who presented to the emergency department with odynophagia and a globus sensation. He was eating fish for dinner and felt as though a piece became stuck in his throat and presented to the ED for evaluation. CT scan of the neck showed a fishbone horizontally stuck in the esophagus at the level of C6 with penetration of the esophageal wall and extraluminal air. The patient went for upper endoscopy where a 2.5 cm fishbone was found in the proximal esophagus, lodged into both walls. A transparent cap was employed during the endoscopic retrieval. The foreign body was then removed with a Raptor grasping device and hemostatic clips were places along the perforated esophageal edges to repair the tear. He subsequently had a barium esophagram, which showed no esophageal leak. His diet was advanced successfully and he was discharged on a 7-day course of augmentin. DISCUSSION: Obtaining a reliable patient history is paramount in determining the correct diagnosis. If the clinical history prompts a high degree of suspicion, obtaining CT scan is the preferred imaging modality. Once the presence of a foreign body is confirmed on imaging, it can be retrieved via endoscopy. Utilizing endoscopic caps can aid in the visualization and retrieval of foreign bodies in the gastrointestinal tract. As seen with our patient, his clinical history created a high suspicion, prompting CT scan, which confirmed the presence of a fishbone lodged in the esophagus. The foreign body was retrieved via upper endoscopy the following morning with improvement in symptoms. His course was notable for esophageal wall penetration, which was successfully repaired endoscopically.Figure 1.: Foreign body in the esophagus with a clear cap in view.