Stuck in the Middle! A Case of Repeated Foreign Body Impaction in Oesophagus

Abstract

Oesophageal foreign body impaction is usually seen in children as well as in adults with varying aetiologies. It is an emergency situation requiring proper evaluation and prompt treatment because of the possible complications like oesophageal perforation, mediastinitis and aspiration. Here, the report presented an interesting case of repeated foreign body impaction in the lower oesophagus of an elderly male. A 76-year-old male patient came to the Emergency Department in a Tertiary Care Center with chest pain and obstruction in the passage of food which had begun several hours prior to visit after having a chicken meal. The patient had presented with similar complaints in the past on three different occasions. The clinical examination was normal. As a part of the treatment, urgent upper gastrointestinal endoscopy was performed by using olympus flexible video endoscope under general anaesthesia, which showed meal impaction in distal oesophagus. The impaction was removed successfully with combination of rat tooth forceps and endoscopic snare. Later on after successful retrieval during his subsequent visit in view of his repeated foreign body impaction, further evaluations including High-Resolution Manometry (HRM) were performed which revealed multiple oesophageal spasms during the passage of food, with premature peristalasis and thereby, it was diagnosed as Diffuse Oesophageal Spasm (DES). The patient was given nitrates and kept on calcium channel blockers for long term medication. DES is an uncommon cause of dysphagia, for which oesophageal manometry is the gold standard procedure. Presence of synchronous contractions in a minimum of twenty for one hundredth of wet swallows (constituting 20%), alternating with normal motility patterns is a diagnostic criteria for DES on manometry. HRM has been a significant improvement in the accuracy of describing the various motility disorders of oesophagus.