Chronically retained esophageal foreign body, a case report

Abstract

Foreign body ingestion is one of the most common pediatric emergencies among infants and young children. Between 80% and 90% of ingested foreign bodies pass spontaneously, 10% to 20% require endoscopic removal, and about 1% necessitates an open approach for removal. A 13-year-old female developed progressive dysphagia over the course of 11 years. The parents reported a history of a foreign body ingestion (a plastic candlepin holder) 11 years before. They were informed that the foreign body would pass spontaneously but they did not recall ever having recovered it. Over the years she was repeatedly taken to various healthcare facilities where chest X-rays were performed and reported as normal, and she was sent home without interventions. When she presented to our clinic, she could swallow chewed solid food only with liquids. A neck examination revealed a bulge on the right anterolateral side. The remainder of the physical examination was unremarkable. An esophagogram revealed an upper esophageal stricture with a diverticulum. Upper GI endoscopy demonstrated a proximal esophageal stricture, while a neck CT scan showed narrowing of the proximal esophagus and a foreign body with a central hole. The impacted foreign body was successfully removed by endoscopy. She was able to swallow solid food for about a year, after which she developed dysphagia again. Endoscopy revealed narrowing at the proximal esophagus. An attempt at esophageal dilation was unsuccessful. She subsequently underwent a cervical exploration, which showed a short proximal esophageal stricture and a diverticulum proximal to the stricture. A diverticulectomy and resection with end-to-end anastomosis were done. Six months after the operation she continues to eat solid foods with some difficulty, but is gaining weight, and remains under close surveillance. Diagnosing non-radiopaque esophageal foreign bodies is challenging in centers with limited resources. Chronically impacted foreign bodies and their complications are difficult to treat due to the lack of a standardized approach.