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
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