University of Nevada School of Medicine Las Vegas, NV
Muthena Maklad, MD1, Muhammad T. farooqui, MD2, Ranjit Makar, MD2, Daisy Lankarani, MD1, Yousif Elmofti, MD3, Gordon V. Ohning, MD, PhD2, Hamza Aziz, MD1; 1University of Nevada School of Medicine, Las Vegas, NV; 2University of Nevada, Las Vegas, NV; 3University of Nevada School of Medicine, Lasvegas, NV
Introduction: Foreign body (FB) ingestion is a common and potentially life-threatening clinical problem with an estimated annual incidence of 120000 cases in the U.S. Large FB occluding the upper gastrointestinal tract may lead to severe clinical complications and are challenging to manage. We present a case of a large stone in the upper esophagus that was successfully removed with combination of rigid endoscopy (RE) and flexible endoscopy (FE).
Methods: 20 y.o. male with no medical history. He presented to the hospital with dysphagia after a fall down a hill during a hike; he reports swallowing a rock during the fall. He complained of emesis, dysphagia to solids and saliva with shortness of breath. On exam vitals were stable. Chest x-ray showed an esophageal FB at the T1-2 level mildly effacing the dorsal aspect of the trachea without significant narrowing. The patient was intubated. The stone was noted in the proximal esophagus, completely obstructing the lumen. Different instruments were used to dislodge the FB including snare, rat-tooth forceps, Roth net were unsuccessful. A biliary balloon placed distal to the FB and inflated up to 15 mm, but it was ineffective. ENT was called to assist. ENT used multiple types of forceps, and a balloon up to 20 mm which failed to remove the FB. A decision was made to carefully push the FB distally into the stomach using a longer rigid esophagoscope. Using a flexible endoscope and a Roth net, the FB was captured in the stomach and brought out through the esophagus; the endotracheal cuff was deflated to reduce the resistance at the upper esophageal sphincter (UES). Inspection of the esophageal mucosa showed only superficial mucosal injury. Stone measured 3.5 cm Discussion: 80–90% of ingested FB pass spontaneously, 10–20% of cases of FB ingestion require endoscopic removal, and less than 1% will need surgery for FB extraction or to treat complications. FB may lead to serious adverse outcomes such as ulceration, obstruction, perforation and even death. For FB in the esophagus, FE is attempted first due to its high success rate. RE may be considered, especially if FE fails or if an FB is wedged in UES. In our case we demonstrate successful removal of a stone from the esophagus using a combination of FE and RE. A multidisciplinary approach with Gastroenterology and ENT may be required in difficult FB cases. From our literature review, there are only 3 reported case reports involving patients with history of mental illness, incarceration or neonate.
Chest x-ray, with arrow pointing to stone in the upper esophagus
Endoscopic view of the stone in the upper esophagus
Stone removed from the esophagus.
Disclosures: Muthena Maklad indicated no relevant financial relationships. Muhammad farooqui indicated no relevant financial relationships. Ranjit Makar indicated no relevant financial relationships. Daisy Lankarani indicated no relevant financial relationships. Yousif Elmofti indicated no relevant financial relationships. Gordon Ohning indicated no relevant financial relationships. Hamza Aziz indicated no relevant financial relationships.