Emergency call: “Doctor I swallowed a stick”

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

Publication History

Article published online:
13 December 2022

• References

• 1 Huang B, Rich H, Simudson S. et al. Intentional swallowing of foreign bodies is a recurrent and costly problem that rarely causes endoscopy complications. Clin Gastroenterol Hepatol 2010; 11: 941-946
• 2 Poynter B, Hunter J, Coverdale J. et al. Hard to swallow: A systematic review of deliberate foreign body ingestion. Gen Hosp Psychiatry 2011; 33: 518-524