Meat Impaction Research Articles

Cola therapy for oesophageal food bolus impactions a case series.

IntroductionThis retrospective case series describes the use of cola to immediately treat complete oesophageal food bolus obstructions in the emergency centre. Short of emergent endoscopy – which is invasive, expensive, not without adverse events, and often unavailable in low-resource settings – no other proven therapies exist to relieve oesophageal food impactions.MethodsWe performed a chart review of adults with complete oesophageal food bolus obstructions presenting to two Dutch emergency centres. Our primary outcome was cola’s success rate in resolving the obstruction. Our secondary outcome was adverse event occurrence.ResultsWe identified 22 cola interventions in 19 patients, the majority of whom (77.3%) were male. The median age was 59 years (IQR 29–73). All presentations were due to meat impaction. Endoscopy revealed relevant upper gastrointestinal pathology in 54.5%. When initiated in the emergency centre, cola successfully resolved 59% of complete oesophageal obstructions. No adverse events were reported in patients successfully treated with cola.DiscussionWhile keenly aware of our retrospective study’s limitations, we found a promising success rate for cola as an acute intervention for oesophageal food bolus impactions. We registered no adverse events attributable to cola. Also, given that cola is cheap, widely available and seemingly safe we believe it can be considered in patients with oesophageal obstructions due to food, either as pre-endoscopy treatment or in case endoscopy is not available at all. We think our findings provide an impetus for prospective research on this intervention.

Graft-versus-host disease-Induced esophageal web.

Endoscopy revealed a chicken meat impaction in the upper esophagus. On food removal, an esophageal web (thin membranous constriction) was revealed at the site and diagnosed as GVHD-induced esophageal web by the endoscopist.

Massive Submucosal Esophageal Tear from Meat Impaction in Candida Esophagitis

Candida species are commensal organisms of different mucous membranes in healthy individuals with the esophagus being a common site of colonization. Candida esophagitis involves the superficial mucosa and transmural invasive candida infection is rare even in immunocompromised patients. Here we report a 49 year-old male who presented with hematemesis after a piece of steak was stuck in his esophagus. He was found on upper endoscopy to have deep esophageal tears, extensive ulcerations and whitish plaque. Biopsies were positive for candida esophagitis and he was subsequently diagnosed with HIV. The patient is a 49 year-old male with history of hypertension that presents with a food impaction in his esophagus after eating steak. He tried to relieve the impaction with self-induced vomiting without relief followed by multiple episodes of hematemesis associated with dysphagia, odynophagia, and severe chest pain. He reports being in usual state of health prior to that incident. He is not on chronic steroids, PPI, or anticoagulant and denies any history of NSAIDs or alcohol abuse. Physical examination was negative for any icteric sclera, palpable crepitus over chest wall or neck, or abdominal findings. CT chest showed no radiopaque foreign body or pneumomediastinum. On emergent EGD the findings were two large submucosal esophageal tears extending 27 to 37 cm from the incisors, diffuse whitish plaques covering the upper esophagus extending to the distal esophagus, and ulcerations of esophageal mucosa but no obvious perforation or food bolus in the esophagus. He was admitted under CT surgery and was kept NPO, on IVF, IV antibiotics and antifungal. Tissue biopsy of the esophagus revealed acute and chronic esophagitis, abundant candida and bacteria. He was positive on HIV screening with a viral load 12,214 and absolute CD4 count 169. A barium esophagram revealed no contrast extravasation. Candida esophagitis is known to occur in immunocompromised hosts but severe complications (i.e perforation, fistula) with esophageal candidiasis are rare and have been mainly reported in diabetic patients with renal transplantations and patients with hematologic malignancy. Unlike eosinophilic esophagitis, food impaction is not often seen in candida esophagitis. The unique highlights of this case are the absence of any prior esophageal or constitutional symptoms and the extent of esophageal mucosal injury sustained from the food impaction in the setting of esophageal candidiasis.Figure 1Figure 2Figure 3

Esophageal foreign bodies in children and adults: 20 years experience

Esophageal foreign object ingestion is frequently seen in all ages. Failure to treat can cause serious complications such as esophageal perforation. The aims of this study were to characterize the clinical features related to foreign objects in the esophagus and to analyze the results of commonly used methods for their removal. We analyzed 20 years of records from Siyami Ersek Hospital, Istanbul and identified 512 cases of foreign objects enlodged in the esophagus. In pediatric patients, the majority were aged between 2-5 years (34.4%), while in adult patients, the majority were above 55 years (38.7%). Coins were the most common foreign object detected in children (68.8%), whereas meat impaction was most common in adults (87.4%). The most common location of the foreign object was the cervical esophagus in children (78.2%), and the thoracic esophagus in adults (66.4%). In 30.8% of adults, there was esophageal or systemic disease. Objects were removed with a Magill clamp in 48.3% of children. Rigid endoscopy was the main treatment in adult patients. Perforation due to endoscopy developed in three patients. Surgical repair was performed on these patients but all died due to mediastinitis. Underlying esophageal or systemic diseases may predispose adults to foreign object ingestion in the esophagus. Improved endoscopic experience and clinical management of thoracic surgeons led to reduced morbidity and mortality in recent years.

An Uncommon Cause of Food Impaction

Purpose: Esophageal food impaction is usually secondary to structural abnormalities of the esophagus such as Schatzki's ring, eosinophilic esophagitis or strictures. Nutcracker esophagus (NE) is an esophageal motility disorder characterized by the presence of hypertensive but peristaltic contraction waves, making food impactions rare. We describe a patient with meat impaction associated with NE. A 66-year-old male presented with chest pain and dysphagia 3 hours after ingesting a large meal. His pain was located in the mid chest associated with difficulty swallowing his own saliva. He denied any history of dysphagia, chest pain or heartburn. Physical exam revealed an alert man in mild distress with pooling of saliva in his mouth. Cardiac, pulmonary and abdominal exams were unremarkable. An EKG and three sets of cardiac enzymes ruled out cardiac causes of chest pain. All the initial laboratory results were normal except for a WBC 11,950; with a normal eosinophil count. A CT of the chest revealed foreign material in the esophagus, consistent with undigested food. Prior to endoscopic evaluation, the patient's symptoms spontaneously subsided. Endoscopy revealed mildly hemorrhagic mucosa in the mid esophagus with no strictures, concentric rings or esophageal furrows. Biopsies of the esophagus were normal, with no evidence of eosinophilic esophagitis. A single contrast esophagram revealed tertiary contractions of the esophagus. High resolution manometry (HRM) (Figure 1) revealed normal peristaltic wet swallows with normal contraction amplitudes at 7 and 11 cm above the LES. At 3 cm above the LES, however, the amplitudes ranged from 196-386 mmHg, consistent with NE. The patient was discharged the day after the procedure and returded 1 month later for follow-up. He remained asymptomatic and no treatment was required. Nutcracker esophagus can be diffuse or segmental. The manometry findings in our patient were consistent with a segmental nutcracker esophagus. Only 4 cases have reported of nutcracker esophagus and food impaction, but ours is the first one diagnosed with high resolution manometry. Although rare, nutcracker esophagus can cause esophageal food impaction and HRM is of paramount importance in diagnosing this entity in minimally symptomatic patients.Figure: [573] High resolution manometry showing hypertensive peristaltic waves in the distal esophagus.

Esophageal foreign bodies: 177 cases

The aim of this study is to assess patients treated for esophageal foreign bodies. The charts of patients (n=177), between January 1994 and April 2009, were investigated retrospectively. Patients' age and gender, locations and types of foreign bodies (FBs) and interventions were taken into consideration. Fifty-seven percent of the patients were male. The youngest patient was 6 months, whereas the oldest was 83 years old. The median age was 9 years. Half of the patients were in their first decade. Treatment took place 11 h (ranging from 1 to 120 h) after impaction of the FB. One hundred fifty-two FBs were removed in 177 patients. Our negative esophagoscopy (n=25) rate was 14%. The FBs were radiopaque in 75% (n=114) and were commonly (71%; n=109) located in the cervical esophagus. Metallic coins (n=81-53%) were the most commonly observed inorganic FB while bones and/or meat impaction (n=54-35%) were the most frequent organic FB. A total of 182 endoscopic interventions were performed on these patients. One hundred eleven of them were esophagoscopy and the remaining 71 were direct laryngoscopy. The FB was pushed into the stomach in 11 patients. Our morbidity rate was 1.6% (n=3). Iatrogenic perforation occurred in two patients. There was no mortality. Esophageal FBs may vary in type: sharp or round objects, metallic, plastic or organic material. FBs are commonly found at pharyngoesophageal junction and usually removed by McGill forceps. Rigid esophagoscopy is used for children and adults because of its large working channel. Rigid instruments are considered reliable and safe for extracting foreign bodies.

Sublingual Nitroglycerine for Esophageal Meat Impaction

Purpose: A 48 year old female presented to a community hospital emergency room with sudden onset of dysphagia to liquids and solids 3 hours after eating meat for supper. She denied heartburn, tobacco or alcohol use and had no previous problems with swallowing. She was not taking any medications and was unable to tolerate saliva. A trial of glucagon resulted in no improvement. The emergency room physician contacted the endoscopist on-call at the teaching hospital who suggested that she be given a trial of sublingual nitroglycerine 0.3 mg. This agent was suggested as it has been shown to cause a significant reduction in lower esophageal sphincter pressure in normal subjects as well as in patients with achalasia, Chagas' disease and esophageal spasm (1-4). Within 20 minutes after sublingual nitroglycerine adminstration, the patient passed the meat bolus spontaneously. She did develop mild transient hypotension from the nitroglycerine which responded to intravenous fluids. Follow-up elective endoscopy 2 months later revealed a Schatzki ring which was dilated with a 48 French Maloney dilator. Biopsies of the esophagus showed only mild non-secific inflammation, without evidence of eosinophilic esophagitis. Based on this experience, it appears that sublingual nitroglycerine may be helpful in emergency room management of esophageal meat impaction and may reduce the need for urgent endoscopy.

Clinical Scenario—An 18-Year-Old With Acute Dysphagia and Meat Impaction

A healthy 18-year-old male subject presented to the emergency department with acute dysphagia and odynophagia immediately after eating steak. He regurgitated several times, with no relief of his symptoms. His medical history was remarkable for asthma and seasonal and environmental allergies, for which he was treated with, as needed, albuterol inhaler and montelukast. He also had a remote episode of apparent anaphylaxis to shellfish requiring an emergency department visit. On examination he was seen in the emergency department in some distress, holding a cup into which he was periodically expectorating saliva.

Synchronized Techniques Resolve Difficult Case of Laryngeal Meat Impaction: A Case Report and Brief Review of Current Management

Airway obstruction by aspirated foods such as meat represents a true emergency. The management of this crisis is definitely aimed at removal of the foreign object. The removal in some patient is accomplished by emergency physician but when the foreign object is distal to the oropharynx, a great challenge is encountered. We report a case of difficult laryngeal meat impaction unresolved by techniques recommended by American Heart Association (AHA) and European Resuscitation Council (ERC). 1, 2 When the exhausted patient became uncooperative, synchronized techniques of sub diaphragmatic thrust and coughing while on sitting position became a successful alternative.

Techniques of foreign body removal in infants and children

Foreign body ingestions are common in pediatric patients and represent a challenge for the pediatric endoscopist. The most common objects ingested by children in the United States are coins, although toys and batteries account for a significant fraction of ingestions. The timing of and requirement for endoscopy is based on the type of foreign body ingested, its location, and the presence or absence of symptoms. In some cases, ingested foreign bodies require urgent removal even in asymptomatic patients. This is the case for example, with esophageal batteries. In smaller pediatric patients, the size of the foreign body is an important factor in determining the timing and requirement for endoscopy and the management may differ as compared to adults. Areas of anatomic narrowing or disease may be an underlying reason why a foreign body becomes lodged and endoscopists are cautioned against blindly advancing a foreign body or meat impaction distally. Various techniques and endoscopic equipment are used to remove ingested foreign bodies in children including specialized forceps, baskets, snares, and friction fit adaptors and these are discussed.

Proximal esophageal meat impaction in a patient with epidermolysis bullosa aquisita (EBA)

Proximal esophageal meat impaction in a patient with epidermolysis bullosa aquisita (EBA)

Proximal esophageal meat impaction in a patient with epidermolysis bullosa aquisita (EBA)

Proximal esophageal meat impaction in a patient with epidermolysis bullosa aquisita (EBA)

3529 UNDERLYING ESOPHOGEAL PATHOLOGY IN MEAT IMPACTION.

Goal:To determine the underlying pathology responsible for dysphagia in patients who presented with meat impaction to Wilford Hall Medical Center and Brooke Army Medical Center(2 military hospitals in San Antonio, TX). Methods:All endoscopy and pathology reports from esophogeal meat impactions were reviewed retrospectively from a 3 year period. All repeat endoscopies and other studies were reviewed to determine an etiology for the meat impaction. Results: There were 70 meat impaction cases in the time period. 81.4%(57/70) had a repeat endoscopy performed and 22.9%(16/70) had biopsies taken. 71.4%(50/70) had dilation performed at index or subsequent endoscopy. A summary of underlying pathology is listed in table 1. Conclusions: At our two institutions, nearly 75% of all meat impactions were caused by either peptic strictures or esophogeal webs/rings. Another 20% of patients had no visible pathology on endoscopy. Rare causes noted included malignancy, a non-specific motor disorder, and recently banded varices. The data indicate nearly 95% of all meat impactions reveal common or no pathology at endoscopy. Goal:To determine the underlying pathology responsible for dysphagia in patients who presented with meat impaction to Wilford Hall Medical Center and Brooke Army Medical Center(2 military hospitals in San Antonio, TX). Methods:All endoscopy and pathology reports from esophogeal meat impactions were reviewed retrospectively from a 3 year period. All repeat endoscopies and other studies were reviewed to determine an etiology for the meat impaction. Results: There were 70 meat impaction cases in the time period. 81.4%(57/70) had a repeat endoscopy performed and 22.9%(16/70) had biopsies taken. 71.4%(50/70) had dilation performed at index or subsequent endoscopy. A summary of underlying pathology is listed in table 1. Conclusions: At our two institutions, nearly 75% of all meat impactions were caused by either peptic strictures or esophogeal webs/rings. Another 20% of patients had no visible pathology on endoscopy. Rare causes noted included malignancy, a non-specific motor disorder, and recently banded varices. The data indicate nearly 95% of all meat impactions reveal common or no pathology at endoscopy.

Treatment of eosinophilic esophagitis with inhaled corticosteroids.

Treatment of eosinophilic esophagitis with inhaled corticosteroids.

Laparoscopic management of paraesophageal hernia: early results.

The objective was to review our early results with laparoscopic repair of paraesophageal hernias to determine the safety, technical feasibility, and short-term outcome of the operation. Twelve patients with a mean age of 75 +/- 1 years underwent laparoscopic repair of a paraesophageal hernia. Principles of open repair, including sac excision, primary crural repair, and pexy, were accomplished laparoscopically in 83%, 83%, and 100% of patients, respectively. In two patients the diaphragmatic defect was closed with mesh. Fundoplication was also performed in seven patients with symptoms of reflux disease. No laparoscopic procedure was converted to an open repair; however, one patient required a postoperative celiotomy to control hemorrhage. Short-term evaluation of all patients postoperatively detected gastroesophageal reflux disease (GERD) in five patients (42%), four of whom did not undergo fundoplication. Two major complications were esophageal perforation and bleeding. Minor complications included atrial fibrillation in two patients, meat impaction in one patient, and a small asymptomatic recurrence in a single patient. Overall patient satisfaction was high. Laparoscopic repair of paraesophageal hernias was safe and technically feasible and warrants further investigation. The incidence of postoperative esophageal reflux, however, is high if an antireflux procedure is not performed. Extensive preoperative evaluation for reflux should objectively identify patients requiring fundoplication and decrease the incidence of postoperative GERD.

Management of foreign bodies of the upper gastrointestinal tract: Update

Management of 242 foreign bodies of the upper gastrointestinal tract are reported. Thirty-nine were in the pharynx, 181 in the esophagus, 19 in the stomach, and 3 in the small bowel. The flexible panendoscope was used 211 times (87.2%) to manage these foreign bodies, while the rigid esophagoscope was used 12 times (5.0%). Two hundred thirty-nine foreign bodies (98.8%) were successfully managed endoscopically. The surgery rate was 0.4%. There was no morbidity or mortality. Twenty-five percent of the cases were done under general endotracheal anesthesia. Coins in the esophagus are removed promptly if in the cervical or mid esophagus, and within 12 hours if in the distal esophagus. Once in the stomach, they will usually pass without difficulty. Meat impaction resulting in an obstructed esophagus is an urgent problem and the bolus should be removed within hours. Sharp and pointed foreign bodies can be very difficult to manage. Dry runs with a reproduction of the foreign body are essential to successful removal. Button batteries lodged in the esophagus represent an emergency and should be removed without delay. Once in the stomach, they will usually pass through the gastrointestinal tract without difficulty. The forward-viewing flexible panendoscope has become the instrument of choice in managing foreign bodies in most tertiary medical centers as well as in the community hospitals. (Gastrointest Endosc 1995;41:39-51.)

Hemorrhagic Pulmonary Edema Associated with Meat Tenderizer Treatment for Esophageal Meat Impaction

We describe a case of acute hemorrhagic pulmonary edema caused by aspiration of Adolph's meat tenderizer, used in an attempt to relieve an esophageal meat impaction. We performed an animal experiment in which bronchial instillation of a similar solution reproduced the clinical findings in our patient. This is a previously unreported and potentially lethal complication of a therapy that has never been submitted to clinical trials. We recommend against the use of this therapy for patients with complete esophageal obstruction or in those otherwise at risk for aspiration.

Enzymatic digestion of esophageal meat impaction. A study of Adolph's Meat Tenderizer.

While a solution of Adolph's Meat Tenderizer (AMT) is commonly used to treat esophageal meat impaction, few studies describe its clinical effects. We examined AMT with regard to (1) its papain activity; (2) its ability to digest meat cubes in vitro; and (3) its effect on rabbit esophageal mucosa. A standard papain assay was developed against which the activity of AMT was compared. Proteolytic activity was detected in AMT only when the papain activators, 0.02 M cysteine and 0.008 M EDTA, were added to the system. Meat cubes incubated in AMT solution exhibited no evidence of digestion as determined by protein release or change in sample weight. A solution of AMT had no adverse effect on normal esophageal mucosa in rabbits, but significantly increased esophagitis when infused onto previously inflamed mucosa. We conclude that AMT solution has no inherent capacity to digest or to reduce the size of an impacted meat bolus, and may, in fact, worsen existing esophagitis.

Glucagon

Glucagon is an important therapeutic agent in critical care medicine. Although its endogenous hormonal functions have been well described, its clinical uses are rarely discussed. Glucagon is effective in the treatment of hypoglycemia, cardiogenic shock and heart failure, propranolol overdose, esophageal meat impaction, ureteral colic due to calculi, and acute diverticulitis. It may prove useful in the treatment of endotoxin and hypovolemic shock as well as toxicity due to excesses of procainamide, quinidine, or ouabain.

Acute esophageal food impaction treated by gas-forming agents.

Impacted meat obstructing the esophagus was successfully treated in 8 patients by oral administration of tartaric acid and sodium bicarbonate. This acid-base mixture produces carbon dioxide, which distends the esophagus and propels the meat into the stomach. The authors have had a 100% success rate with no complications and recommend that this procedure be the first treatment attempted for meat impaction in the esophagus.