Think Twice Before Extracting a Harmless Foreign Body From the Upper Esophagus

Abstract

An 86-year-old man with a past medical history of squamous cell carcinoma of the larynx and total laryngectomy with tracheostomy presented for evaluation of severe iron deficiency anemia (hemoglobin of 6.4 g/dL). Our patient had no upper gastrointestinal symptoms and underwent upper endoscopy. Upon slowly endoscopic withdrawal, a foreign body in the upper esophagus was visualized. This looked like the bumper from a conventional percutaneous endoscopic gastrostomy (Figure A). Careful investigation of the patients' medical records revealed that 2 years ago, in March 2017, owing to odynophagia, he also underwent a gastroscopy with similar findings (Figure B). Moreover, he underwent a video-swallow study that demonstrated a normal swallowing mechanism without evidence of pooling of contrast or aspiration. In November 2018, the patient had a cervical and chest computed tomography san with no metastasis (Figure C, D). Correlating these clinical, endoscopic and radiological findings with the patient's history and background what is the diagnosis of the esophageal foreign body? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.