An Ingested Foreign Body Performing a Vanishing Act

Abstract

An 86-year-old man with chronic acid reflux, cryptogenic cirrhosis complicated by hepatic encephalopathy, ascites, and nonbleeding esophageal varices presented to the emergency department with progressive epigastric pain. A portable chest radiograph revealed a 20-mm, disc-like radiopaque foreign body within the middle one-third of the esophagus, which was seen migrating into the gastric fundus 1 hour later on sequential noncontrast abdominal computed tomography imaging (Figure 1). The patient denied foreign-body ingestion, including button battery or coin. Given the history of hepatic encephalopathy and the resemblance of a button battery on imaging, the patient underwent an emergent push upper endoscopy in adherence with guidelines from the American Society for Gastrointestinal Endoscopy on prompt removal of suspicious ingested foreign bodies. 1 The foreign body was not found on endoscopy to the proximal jejunum. After procedure, follow-up radiographs no longer demonstrated the foreign body, and it seemed to have vanished.