Esophageal Foreign Body Ingestion Research Articles

Frequency of oesophageal foreign bodies ingested by children presenting to the ENT department.

Objective: To determine the frequencies of different esophageal foreign bodies ingested by children presenting to Ayub Teaching Hospital Abbottabad. Study Design: Cross-sectional study. Setting: Department of Otorhinolaryngology, Ayub Teaching Hospital Abbottabad. Period: 2nd July 2020 to 31st December 2022. Material & Methods: Following the application of inclusion and exclusion criteria, a total of 168 patients, aged between 6 months and 11 years, presenting with suspected esophageal foreign bodies, were included in the study after obtaining written consent. Socio-demographic information, clinical history, and symptoms were carefully recorded. Diagnostic procedures included neck X-rays, extended to the chest, and abdominal X-rays as necessary. Rigid esophagoscopy, performed under general anesthesia, was utilized to confirm and remove foreign bodies. Subsequently, the nature and type of the extracted foreign bodies were identified and documented using a standardized pro forma. Results: The mean age of the patients was 5.63 ± 3.097, ranging from 1 to 11 years. Regarding the gender distribution, 105 (62.5%) were male, and 63 (37.5%) were female. When considering the types of foreign bodies, 129 (76.8%) presented with coins, 12 (7.1%) with metallic objects, 7 (4.2%) with battery cells, and 9 (5.4%) with fruit seeds. Additionally, there were a few cases of chicken bones, fish bones, and safety pins, accounting for 9 (5.4%) in the category of other foreign bodies. Conclusion: This study underscores the frequent occurrence of esophageal foreign body ingestion in young children, particularly males under the age of 5, with coins identified as the predominant culprits.

S588 Cap Assisted Endoscopic Treatment of Esophageal Food Bolus and/or Foreign Body Ingestion: A Systematic Review and Meta-Analysis

Introduction: Esophageal food bolus and/ or foreign body (FB) impaction is one of the most common gastrointestinal emergencies where early endoscopic intervention is warranted. Early time to intervention with faster procedure time are associated with good patient outcomes. In recent literature, cap assisted endoscopic removal of esophageal FB seems to be associated with favorable outcomes as compared to conventional methods. This meta-analysis reports on the pooled outcomes of cap-assisted endoscopic removal of esophageal FB. Methods: We conducted a comprehensive search of several databases including Medline, Scopus, Embase, from inception to February 2022, to identify studies reporting on the use of cap in endoscopic treatment of esophageal FB. Standard meta-analysis methods and random effects model was used to calculate the pooled odds-ratio (OR) and mean-difference (MD) with corresponding 95% confidence intervals (CI). I2% statistics was used to assess the heterogeneity. Results: Six studies were included that evaluated 677 patients treated with cap-assistance and 694 patients treated with conventional methods. Peptic stricture (32%) and eosinophilic esophagitis (20%) were the most common esophageal disorders. Cap-assisted method demonstrated statistically significant pooled OR for technical success: 7.1 (95% CI [1.9-26.9, p=0.004, I 2%=0]), and enbloc removal: 26.6 [17.6-40.2, p< 0.001, I2%=0], with significantly faster procedure time, MD: -4.6min [-6.5to-2.8, p< 0.001, I2%=99]; when compared to conventional method. Better technical success was achieved with cap-assisted method done under general-anesthesia (OR: 8.7, 1.6-47.7, p=0.01, I 2%=0), but faster procedure time was noted with cap-assisted method performed without general-anesthesia (MD: -1.5, -2.7to-0.4, p=0.01, I2%=99). Pooled adverse events were comparable. However, pooled OR of mucosal tear was significantly less with the use of cap in food-bolus impactions (OR: 0.07, 0.01-0.38, p=0.02, I2%=0). No airway related adverse events were reported when general anesthesia was not used. (Figure) Conclusion: This meta-analysis demonstrates significantly better pooled technical success, enbloc removal and faster procedure time with cap-assisted endoscopic removal of esophageal food-bolus and/ or foreign-body impaction as compared to conventional method. With cap-assistance, faster procedure time seems achievable without the need for general anesthesia. However, additional randomized controlled trials are required to further validate this finding.Figure 1.: Summary of pooled results

Salvaged, Staged, and Safer Management of Aortoesophageal Fistula and Mediastinitis After Removing a Pork Bone: A Case Report

Aortoesophageal fistula (AEF) caused by esophageal foreign body (EFB) ingestion is a life-threatening condition with a very low survival rate. However, the optimal management strategy remains undetermined. Here, we describe our successful management of a patient with AEF and mediastinitis. A 36-year-old man developed persistent chest and back pain and vomited fresh blood three days after removal of a pork bone in the esophagus under endoscopy in a local hospital. Computed tomography (CT) confirmed bilateral pulmonary infections, mediastinitis, and fistula of the aortic arch. After a multidiscipline discussion, a comprehensive staged strategy was made including salvaged thoracic endovascular aortic repair (TEVAR) to control fatal bleeding, adequate mediastinal debridement, drainage with cervical incision, and video-assisted thoracoscopic surgery, as well as jejunostomy to prevent nasal or gastrostomy reflux from aggravating the mediastinal infection. Furthermore, systematic personalized nutrition support and antibiotics were provided. The patient recovered well and has survived for 50 months until now. Careful assessment should be made with CT to ascertain the risk of AEF before and after the removal of EFB. A salvaged staged strategy of TEVAR with adequate mediastinal debridement and drainage in a less invasive approach may be a safer alternative for AEF patients with infections caused by EFB.

Cap-assisted endoscopic treatment of esophageal food bolus impaction and/or foreign body ingestion: a systematic review and meta-analysis.

Esophageal food bolus and/or foreign body (FB) impaction is a common gastrointestinal emergency. This meta-analysis reports on the pooled outcomes of cap-assisted endoscopic removal of esophageal FB. We conducted a comprehensive search of several databases (inception to February 2022) to identify studies reporting on the use of a cap in the endoscopic treatment of esophageal FB ingestion. A random effects model was used to calculate the pooled odds ratio (OR) and mean difference (MD), and I2 values were used to assess the heterogeneity. Six studies were analyzed that included 677 patients treated with cap-assisted and 694 with conventional endoscopy. The cap-assisted method demonstrated statistically significant superiority regarding technical success (pooled OR 7.1, 95% confidence interval [CI] 1.9-26.9; P=0.004), en bloc removal (pooled OR 26.6, 95%CI 17.6-40.2; P<0.001), as well as a significantly shorter procedure time (4.6 min, 95%CI -6.5 to -2.8; P<0.001), compared to conventional methods. Better technical success was achieved with the cap-assisted method performed under anesthesia (OR 8.7, 95%CI 1.6-47.7; P=0.01); however, a shorter procedure time was noted for the cap-assisted method without anesthesia (MD -1.5, 95%CI -2.7 to -0.4; P=0.01). Pooled adverse events were comparable. Pooled OR for mucosal tear was significantly lower with cap in food bolus impaction (OR 0.07, 95%CI 0.01-0.38; P=0.02). Cap-assisted endoscopic removal of esophageal FB is associated with better technical success and en bloc removal, and a shorter procedure time compared to conventional methods, with comparable adverse events.

Approach to pediatric esophageal foreign body ingestion: An experience of 117 cases in a tertiary care center

Background: Foreign body (FB) ingestion is a frequent home accident in the pediatric population and is one of the leading causes of morbidity and mortality in children. We aimed to describe the problem of pediatric esophageal FB ingestion at King Abdulaziz University Hospital over 10 years regarding patient, visit, and management characteristics and identify the pediatric specialty team that was called first to the emergency department in such cases. Materials and Methods: This retrospective study included 117 pediatric patients admitted for esophageal FB ingestion in a tertiary care center in Saudi Arabia from 2011 to 2020. We used Chi-squared and one-way analysis of variance tests to determine the associations. Data on demographic and clinical variables were compared between patients with and without neurodevelopmental disabilities, and their associations were assessed. Results: The mean age of patients was 4.7 ± 3.7 years, with slightly higher rates in males (57.3%). Six patients (5.1%) had a history of preexisting esophageal conditions, and five (4.3%) had previous FB ingestion. The most commonly ingested item was a coin (n = 53) and was mostly located in the upper esophagus (n = 56). Gastrointestinal and respiratory symptoms occurred in 78 and 29 patients, respectively. The Otolaryngology Department contributed the highest number of admissions (63.8%). Conclusion: FB ingestion is common in Saudi Arabian preschoolers. These data indicate the need for caregivers to be educated about FB ingestion. Additional investigations should emphasize addressing the consequences of FB ingestion.

Retrospective Analysis of Esophageal Foreign Body Ingestion: Differences Among Weekday, Weekends, and Holidays.

PurposeCurrent data on the occurrence of EFBs in relation to different time periods are scant. The purpose of this study was to compare the occurrence, type and location of EFBs in people who presented at our center on weekdays, weekends and holidays.Patients and MethodsA retrospective analysis of patients (n=1353) received rigid esophagoscopy for foreign body extraction under general anesthesia from January 2018 to 2020 December.ResultsThe occurrence of EFB ingestion was significantly higher (p<0.05) on holidays (2.75/day) than on weekdays (0.91/day) and weekends (1.46/day). Patients were much older on holidays, with a mean age of 58.18 ± 17.34 years, than patients on weekdays (54.71 ± 16.71 years) and weekends (55.05 ± 17.36 years).ConclusionOur findings demonstrate that EFB ingestion is most likely to occur on weekends and holidays, and elderly patients should be advised to chewing slowly and eating non-nuclear jujube, especially during holidays, to minimize their risk.

Chest CT for the Diagnosis of Pediatric Esophageal Foreign Bodies

Foreign body ingestion is a common problem in children. Radiography is the mainstay of imaging, but many radiolucent items go undetected without further imaging by fluoroscopic esophagram. While studies in adults support the use of computed tomography (CT) for esophageal foreign body ingestion, CT has historically not been used in children given the typically higher radiation doses on CT compared with fluoroscopy. In distinction to an esophagram, CT does not require oral contrast nor presence of an onsite radiologist and can be interpreted remotely. At our institution, a dedicated CT protocol has been used for airway foreign bodies since 2015. Given the advantages of CT over esophagram, we retrospectively reviewed institutional radiation dose data from 2017 to 2020 for esophagrams, airway foreign body CT (FB-CT), and routine CT Chest to compare effective doses for each modality. For ages 1+ years, effective dose was lowest using the FB-CT protocol; esophagram mean dose showed the most variability, and was over double the dose of FB-CT for ages 5+ years. Routine CT chest doses were uniformly highest across all age ranges. Given these findings, we instituted a CT foreign body imaging protocol as the first-line imaging modality for radiolucent esophageal foreign body at our institution.

History and radiographic findings as predictors for esophageal coins versus button batteries

ObjectiveTo determine if clinical history and radiographic findings are reliable predictors for coin versus button battery in children presenting with esophageal foreign bodies to accurately guide decision making regarding the urgency of removal. MethodsA retrospective chart review was conducted in a single pediatric tertiary care center of all children who presented with suspected coin or button battery esophageal foreign body ingestion from 2017 to 2019. Patients with documented surgical removal, completed consultation notes, and available radiographic studies were included. Descriptive statistical analysis was performed and predictive characteristics of the diagnostic tests were calculated. Results139 patients met inclusion criteria for the study. Of 5 patients who had esophageal button batteries removed, clinical history was concerning for button battery in 2; accuracy of 12.35%. However, radiology reports suggested a battery in all 5. The negative predictive value for radiology alone for diagnosis of button battery was 97% with 81% accuracy. The clinical history for coin foreign body was accurate in 85.28% while radiography was 87% accurate. Wait time on average for all coin foreign body cases was 6.3 h. Day cases waited on average 5.5 h while after-hours cases waited a statistically significantly longer 7.5 h (p = 0.006). ConclusionButton batteries, while clinically important emergencies, are rare esophageal ingestions. Radiography has a strong negative predictive value for button battery. Children whose radiographic studies do not demonstrate concern for button battery could be considered for delayed elective removal. This could allow children to complete a period of observation at home, thereby reducing prolonged in-house wait times prior to operative removal.

Likelihood and outcome of esophageal perforation secondary to esophageal foreign body in dogs.

OBJECTIVE To determine the likelihood and outcome of esophageal perforation secondary to an esophageal foreign body (EFB) in dogs. DESIGN Retrospective observational study. ANIMALS 125 dogs evaluated for EFB at 2 veterinary teaching hospitals from January 2005 through December 2013. PROCEDURES Data were retrieved from the medical record of each dog regarding variables hypothesized to be associated with esophageal perforation, whether esophageal perforation was present, and survival to hospital discharge. Variables were examined for associations with various outcomes. RESULTS Bones (55/125 [44%]) and fishhooks (37/125 [30%]) were the most common types of EFBs. Fifteen (12%) dogs had an esophageal perforation (10 with a fishhook EFB and 5 with a bone EFB). No association was identified between dog body weight and esophageal perforation. Esophageal perforation was more likely in dogs with a fishhook EFB (10/37 [27%]) versus other EFBs (5/88 [6%]; OR, 6.1; 95% confidence interval, 1.9 to 9.6). Median interval from fishhook or bone ingestion to initial evaluation was significantly longer for dogs with (12 and 96 hours, respectively) versus without (1 and 24 hours, respectively) perforation. Thirteen of 15 (87%) dogs with esophageal perforation survived to hospital discharge, including all 10 dogs with perforation secondary to fishhook ingestion. Eight survivors with esophageal perforation required no surgical intervention. CONCLUSIONS AND CLINICAL RELEVANCE Esophageal perforation was uncommon in the evaluated dogs with an EFB, and no surgical intervention was required for a large proportion of them. Fishhooks and delay between EFB ingestion and initial evaluation were risk factors for perforation.

Button Battery in Esophagus

History of present illness: A 2-year-old male was brought to the emergency department by his parents after a brief choking episode at home and the inability to tolerate oral liquids afterwards. The patient’s mother noticed she was missing a button battery on the counter and suspected her child had swallowed it. On exam, patient had no active drooling or vomiting. His airway was patent with no respiratory distress or stridor. No foreign body was visualized in the oropharynx. Abdominal exam was unremarkable. Significant findings: Chest radiograph showed the presence of a round radiopaque foreign body in the mid- chest. It was suspected to be in the esophagus rather than in the trachea due to the en-face positioning of the foreign body. The foreign body demonstrated two concentric ring circles concerning for a “double ring” or “halo" sign, which was suggestive of the presence of a button battery rather than a coin. Discussion: Button battery (BB) ingestion is a potentially very dangerous condition. Over 3,300 exposures are reported annually to the American Poison Control Centers.1 Once a foreign body is ingested, it risks lodging at three anatomically narrow areas of the esophagus: the upper esophageal sphincter or the thoracic inlet (70% of foreign bodies), the aortic notch (20%), and the lower esophageal sphincter (10%).2 If a foreign body becomes lodged in the esophagus, it can cause obstructive-like symptoms such as dysphagia, aspiration, and there is risk of perforation through the esophageal wall.Esophageal foreign bodies can cause dysphagia, aspiration, and perforation; however, BB ingestion causes additional risks of caustic necrosis from the isothermal hydrolysis reaction of the battery against the esophagus lining. Significant caustic burns can occur in as little as two hours after ingestion.1,3 This tissue injury can lead to the development of devastating conditions such as tracheoesophageal fistula, aortoenteric fistula, vocal cord paralysis, and mediastinitis, all of which can be fatal.2 As a result, patients with esophageal BB must undergo emergent direct laryngoscopy and esophagoscopy for removal under direct visualization as soon as possible. 1 This patient underwent esophagoscopy with subsequent removal of a 2 centimeter lithium button battery; direct visualization showed some edema around the mucosa but no signs of stricture or perforation. The patient subsequently tolerated food and was discharged home the next day. Topics: Button battery, esophageal foreign body ingestion.

Incidence and Clinical Features of Esophageal Perforation Caused by Ingested Foreign Body

Esophageal perforation is a rare but often a life-threatening condition. However, the incidence and clinical features of esophageal perforation caused by ingested foreign body are unknown. This study investigated the incidence of esophageal perforation caused by ingested foreign body and evaluated the clinical features and outcome of patients with esophageal perforation. Among a total of 196 adult patients with confirmed esophageal foreign body and complained of at least one of the related symptoms at the emergency department between January 2000 and July 2008, 18 patients with esophageal perforation due to esophageal foreign body ingestion were included in the study. Data were collected by retrospectively reviewing the electric medical records. The incidence of esophageal foreign body and esophageal perforation in adults was 19.4% (196/1,009) and 1.8% (18/1,009), respectively. Chest pain was the most common symptom and fishbone was the most common foreign body causing esophageal perforation. Mediastinitis or mediastinal abscess occurred in 13 patients (13/18, 72.2%). About half (8/18) of the patients were admitted to the intensive care unit but there was no in-hospital mortality. The incidence of esophageal perforation in patients with foreign body ingestion was low but it increased up to 9.2% in patients with esophageal foreign body. However, prognosis was favorable with timely proper treatment. Chest pain can be an ominous sign indicating the presence of esophageal perforation in patients with esophageal foreign body.

Insidious Threat of Children: Esophageal Foreign Body Ingestion

Objective: Foreign body ingestion commonly occurs in children. Objects that may not easily pass the esophagus cause severe complications, such as impaction, perforation, and obstruction. Different methods are used for their removal. We aimed retrospectively to analyze the cases in which we performed emergent esophagoscopy. Material and Methods: Between 2002 and 2013, 732 children with suspicion of foreign body ingestion were studied. Of them, 720 underwent emergency intervention. Objects located at the first narrowing of the esophagus were removed under sedation, and the remaining objects were taken out under general anesthesia with the aid of rigid esophagoscopy. Results: The mean age of the children was 3.9 years (range 1 month and 16 years). Coins in 648 cases and a variety of objects, opaque and non-opaque, were removed under direct vision. Urgent intervention was carried out in 6 cases with dyspnea, in 2 delayed cases, and in 3 patients with esophageal perforation. Successful removal was performed in 69 patients (95.8%). Perforation occurred in 3 cases. Removal was succeeded within surgery in 2 cases (2.7%). One patient died. Conclusion: A delay in esophageal body ingestion increases the complication rate. Round batteries and objects that are non-oval, long, large, and spiky should be dealt with great attention. (JAEM 2014; 13: 159-61)

A Neglected Risk Factor of Esophageal Foreign Body Ingestion in Adults: Complete Dentures

Aim: There are many reports on the ingestion of foreign bodies in the esophagus; however, little is known about complete dentures as a risk factor. Material and Methods: We conducted a retrospective analyses of 11 adult patients treated for suspected esophageal foreign body between March 2008 to December 2012. Results: Out of 11 patients, 45.5% (n = 5) were male and 54.5% (n = 6) were female, and with the mean age of 47. Esophageal foreign bodies were found and retrieved or pushed into the stomach in all cases. Bones (n = 9, 81.8%) were the most common ingested foreign body. Four patients (36.4%) had a history of using complete dentures and two patients (18.2%) had a single-tooth replacement. Of these patients, the most common location of the foreign body was in the first narrowing (n = 7, 63.6%), followed by the mid-third (n = 3, 27.3%). The duration of hospitalization ranged between 1 to 37 days (median: 3 days; mean: 6.3 days), one patient (9.1%) had a complication, an esophageal perforation. Conclusion: Edentulism is the result of repeated tooth extractions. It is estimated that 17% of the adult population has one-arc or two-arch edentulism and are candidates for complete dentures. Therefore, the fact that a finding of 36.4% of patients who were using complete dentures in esophageal foreign body patients greatly exceeds the general average. Thus, using complete dentures increases the frequency of esophageal foreign bodies and is one of the risk factors for such an occurrence. Keywords: Complete dentures, foreign body, esophagus, endoscopy, impaction. Read more →

Fatal aorto-esophageal fistula in child: A case report

Esophageal foreign body ingestion is especially frequent in childhood and may cause fatal complications in case of late diagnosis and delayed treatment. We present a case of 2-year old girl who was admitted to emergency department with massive bleeding. However, she died due to an unrecognized foreign body resulted an aorto-esophageal fistula.At autopsy an aorto-esophageal fistula was detected by gross examination. Tissue samples were obtained from the organs and fistula region. In histopathological examination, a calcified body with multinucleated giant cell and surrounding granulation tissue was detected at the bleeding site. An ulcerated fistula tract ran from the intima to the adventitia, passing through layers of esophageal wall was also noticed.The mortality rate for foreign body ingestion is less than 1%, except in cases of perforation. Therefore the presented case is among rare examples of fatal foreign body ingestions.

Diagnosis and treatment of nine cases with carotid artery rupture due to hypopharyngeal and cervical esophageal foreign body ingestion

The aim of our study is to present our experience in the diagnosis and treatment of patients with carotid artery rupture (CAR) due to foreign body ingestion. A total of nine admissions with CAR due to foreign body ingestion were recorded in Second Xiangya Hospital between 1969 and 2011. The carotid artery was sutured with muscle flap coverage in six cases, ligated in three cases. We retrospectively compared different surgical procedures of the patients and their clinical outcomes. Results show that CAR was found in all of these nine cases in imaging examinations or surgery. Among these six patients treated by suture of the carotid artery, five patients had a complete recovery without any complications, one patient underwent common carotid artery (CCA) ligation after suture surgery, but finally died of massive hemorrhage due to uncontrollable infection with carotid artery erosion. Among these three patients treated only by CCA ligation, one patient had no complications, one patient had hemiplegia, and one patient died of severe cerebral edema. Hence, timely diagnosis and open surgery are important for the patients of CAR due to foreign body ingestion. Suture of the carotid artery with muscle flap coverage is a better method compared with ligation of the carotid artery in the treatment of CAR.

Study of clinical treatment of esophageal foreign body-induced esophageal perforation with lethal complications

Esophageal foreign body-induced esophageal perforation is a lethal complication and its treatment very complex. We had reviewed 1,428 patients with esophageal foreign body, who were hospitalized and treated over the past 25 years. A classification summary was made of 121 patients (of these 1,428 cases) who presented with esophageal foreign body-induced perforation and complicated cervical abscess, mediastinitis, and mediastinal abscess. This summary considered foreign body types, location and lodging duration, complications, and surgical approaches. Among these 121 patients, esophageal foreign bodies in 81 patients were successfully extracted via esophagoscope or fiber optic esophagoscope. Cervical esophageal foreign bodies in 22 patients were extracted by esophagoscope and lateral cervical incision (n = 6) and simple lateral cervical incision (n = 16). Thoracotomy was performed to remove thoracic esophageal foreign bodies in 18 patients with 10 successes and 8 failures. Of the 121 patients, 67 patients with cervical abscess were cured by means of lateral cervical abscess incision and drainage, esophageal stent placement, and esophageal perforation repair with pedicle myolemma or pedicle muscular periosteum flap. 54 patients with mediastinitis and/or abscess were all cured, except one mortality, by means of mediastinotomy and drainage or/and closed-chest drainage, simple esophageal repair, esophageal repair with pedicle myolemma or pedicle muscular periosteum flap and stent placement for esophageal perforation, and esophageal exclusion plus two-stage gastric-pharyngeal anastomosis. In the treatment of esophageal foreign body-induced severe complications, various therapies should be applied simultaneously. Lateral cervical incision should be made immediately to remove the foreign bodies if the foreign body extraction under esophagoscope proves to be a failure after repeated attempts, or esophageal perforation develops during the procedure, or should cervical abscess develop. Mediastinotomy and drainage or/and closed-chest drainage should be carried out as early as possible when mediastinitis and/or mediastinal abscess develops after esophageal foreign body ingestion.

Endoscopic management of suspected esophageal foreign body in adults

Foreign bodies should not be allowed to remain in the esophagus beyond 24 hours after presentation. However, some patients with esophageal foreign body ingestion do not come to the hospital immediately and may delay medical intervention from the time of ingestion. The aim of this study was to investigate the outcomes of adults with suspected esophageal foreign body ingestion according to the time of ingestion and types of foreign bodies. A total of 326 adult patients (151 men and 175 women) were analyzed, and divided into two groups according to the time period: within or beyond 24 hours from ingestion to endoscopic intervention. A total of 172 patients (52.7%) were found to have ingested foreign bodies; 73.5% were removed smoothly, 10.3% were treated by push technique and 16.0% with failed retrieval received alternative treatments. A higher proportion of patients in the beyond-24 hours group suffered from odynophagia (25.9 vs. 12.9%, P < 0.05). Negative identification of esophageal foreign bodies was more frequent in the beyond-24 hours group (67 vs. 40.2%, P < 0.05), but these patients showed higher proportions of esophageal ulcers (21.1 vs. 7.2%, P < 0.05). The beyond-24 hours group also showed a significantly higher rate of foreign bodies in the lower esophagus (40.0 vs. 15.3%, P < 0.05). Patients with esophageal food bolus impaction had significant delayed endoscopic intervention, longer therapeutic endoscopic time, higher proportions of esophageal cancer, stricture and fewer complications. Endoscopic intervention within 24 hours from the time of ingestion should be considered early in adults, because delaying intervention may produce more symptomatic esophageal ulcerations with odynophagia.

Esophageal foreign body as a cause of upper gastrointestinal hemorrhage: case report and review of the literature

Foreign body ingestion is a common complaint in the emergency department. Severe upper gastrointestinal (GI) hemorrhage is a rare complication of foreign body ingestion and is always considered to signal aortoesophageal fistula (AEF). We report a rare case of a 65-year-old man with upper GI hemorrhage caused by an ingested duck bone 10 days previously. Instead of AEF, massive erosion and edema were found in the esophagus, highlighting the potentially complex pathology of foreign body ingestion. A literature review of the recognized clinical features of esophageal foreign body is described. Some practical points and pitfalls in the management of esophageal foreign body are presented. For patients with a history of esophageal foreign body ingestion, the clinician must maintain a high index of suspicion and must endeavor to obtain a full history.