Foreign bodies represent one of the most frequent emergencies in the practice of gastroenterology. About 80 % of cases resolve or the foreign body is passed spontaneously. Approximately 10 %–20 % of foreign bodies require endoscopic extraction and fewer than 1 % require surgical removal 1 .
A 52-year-old man arrived at the emergency department complaining of abdominal pain that had developed over 24 hours. The pain had started soon after he had swallowed a wooden stick, following auditory hallucinations that instructed him to do so. On physical examination the foreign body was palpable in the mesogastrium, with pain on mobilization ( Video 1 ).
Video 1 Management of ingested foreign body 30 cm in length: physical examination; endoscopy showing a portion of a wooden artifact, as well as multiple splinters, erythema and necrotic changes in the esophageal mucosa; and finally surgical removal.
Abdominal tomography ( Fig. 1 ) and volumetric reconstruction ( Fig. 2 ) were performed to determine the dimensions of the artifact and any signs of perforation. Endoscopy was performed, and at 20 cm from the dental arch a distal portion of the foreign body corresponding to a wooden artifact was evident, with multiple mucosal lacerations and wood splinters located in the esophageal mucosa; in addition, there were erythematous and necrotic mucosal changes ( Fig. 3 , Video 1 ). An unsuccessful attempt was made to remove the foreign body using a loop clamp. It was decided to proceed with surgery.
Fig. 1.
Coronal abdominal computer tomography image in pulmonary window: the hypodense area completely occupies the esophagus including its abdominal portion, and corresponds to a foreign body approximately 30 cm in length.
Fig. 2.
Volumetric reconstruction shows a foreign body occupying the entire esophagus, not affecting the trachea and without signs of perforation.
Fig. 3.
The wooden artifact as seen in the esophagus.
Gastrotomy was performed, and a long wooden artifact, which was curved, 30 cm long, and about 2 cm in diameter, was extracted ( Fig. 4 , Fig. 5 ; Video 1 ). The patient’s postoperative course was adequate; mental health evaluation led to a diagnosis of schizophrenia as a personality disorder.
Fig. 4.
The foreign body was removed surgically.
Fig. 5.
Foreign body measuring 30 cm in length and 2 cm in diameter.
Intentional ingestion of foreign bodies occurs in a relatively small number of psychiatric patients. Endoscopic extraction is effective and safe; however in rare cases such as this one, general anesthesia and surgical extraction are mandatory. The esophageal foreign body in the present case is the largest currently reported 2 .
Endoscopy_UCTN_Code_CCL_1AB_2AF
Footnotes
Competing interests The authors declare that they have no conflict of interest.
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References
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