Nilesh B. Shukla, MD The Valley Hospital, Glen Rock, NJ
Introduction: This is a case of a foreign body ingestion in an elderly patient.
Case Description/Methods: Mr. M is an 85 year old man with history of atrial fibrillation on eliquis, history of colon cancer in 2000, prostate cancer, hypertension, hyperlipidemia, non-insulin dependent diabetes mellitus, and hearing deficit who presented to the emergency department after realizing that he could not hear his wife calling him for breakfast. He thought he had accidentally swallowed the button batteries to his hearing aids. He could not find his hearing aids at home. He reported that the batteries were mixed with his pills and he swallowed all of them at once.
Chest XRay showed two adjacent atypical appearing foreign bodies with the appearance of hearing aids in the region of the gastric antrum.
An urgent upper endoscopy was performed under general anesthesia to retrieve the foreign bodies. Each hearing aid was removed carefully using a Roth net.
The hearing aids were cleaned and returned to the patient. He was then immediately able to hear his wife say, “Come on dear, that is enough excitement for one day. It is time to go home!” The couple happily walked out of the hospital.
Discussion: Asymptomatic foreign body ingestion in the elderly is an under-recognized problem. This patient had no abdominal complaints and was unaware of swallowing the entire hearing apparatus.
An early endoscopy is necessary for improving the likelihood of finding and retrieving the foreign body. In our case, the endoscopy was performed within 45 minutes of the patient’s presentation to the emergency department.
Identifying the location and size of the foreign body is important in determining the optimal instruments to be used to retrieve the items. A chest xray helped identify the foreign bodies in the gastric lumen. Their size as noted on xray reassured the endoscopist on being able to encounter the pieces endoscopically.
Various options are available for retrieving foreign bodies from the stomach. These include large caliber forceps, Roth net, retrieval baskets, and grasping prongs. The choice of which to use can be determined based on the size of the foreign body.
Prevention of foreign body ingestion is of utmost importance in reducing risks and complications to the patient. Educating the elderly population on avoiding taking more than one medication at a time and identifying the pill by name before consuming it may help diminish the risk of such accidents. This should be emphasized at every medical encounter.
Figure: Hearing aides can be hazardous to your GI tract!
Nilesh Shukla indicated no relevant financial relationships.
Nilesh B. Shukla, MD. P1505 - Hear Me Now! Be Careful With Your Pills, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.