Endoscopic extraction of a submucosal esophageal foreign body piercing into the thoracic aorta:A case report

BACKGROUND Aorto-esophageal injury is a rare but life-threatening complication of esophageal foreign bodies,which typically requires open surgery.The best way to treat patients with this condition remains unclear.To date,few reports have described an aortic wall directly penetrated by a sharp foreign body.Here,we present a rare case of a fishbone completely embedded in the esophageal muscularis propria and directly piercing the aorta,which was successfully treated by endoscopy and thoracic endovascular aortic repair(TEVAR).CASE SUMMARY We report the case of a 71-year-old man with a 1-d history of retrosternal pain after eating fish.No abnormal findings were observed by the emergency esophagoscopy.Computed tomography showed a fishbone that had completely pierced through the esophageal mucosa and into the aorta.The patient refused to undergo surgery for personal reasons and was discharged.Five days after the onset of illness,he was readmitted to our hospital.Endoscopy examination showed a nodule with a smooth surface in the middle of the esophagus.Endoscopic ultrasonography confirmed a fishbone under the nodule.After performing TEVAR,we incised the esophageal mucosa under an endoscope and successfully removed the fishbone.The patient has remained in good condition for 1 year.CONCLUSION Incising the esophageal wall under endoscope and extracting a foreign body after TEVAR may be a feasible option for cases such as ours.

Hepatic abscess caused by esophageal foreign body misdiagnosed as cystadenocarcinoma by magnetic resonance imaging:A case report

BACKGROUND Foreign bodies stuck in the throat and esophagus can be discharged through the digestive tract.Esophageal-lodged foreign bodies can cause secondary injury or detrimental response,with hepatic abscess being one such,albeit rare,outcome.Review and discussion of the few case reports on such instances will help to improve the overall understanding of such conditions and aid in differential diagnosis to improve patient outcome.CASE SUMMARY A 51-year-old female patient with pre-existing diabetes visited our hospital following a 15-d experience of chills and fever.Both plain and enhanced magnetic resonance imaging and color Doppler ultrasound examination of the liver and gallbladder revealed a space-occupying lesion in the caudate lobe of the liver(7.8 cm×6.0 cm×5.0 cm).Initially,a malignant tumor was suspected,but differential diagnosis was unable to exclude the possibility of hepatic abscess.Conservative anti-infection therapy produced a less than ideal outcome.Additional examination by hepatobiliary imaging with computed tomography suggested a foreign body present in the upper abdomen and hepatic abscess,and subsequent endoscopy revealed a sinus tract in the anterior wall of the duodenal bulb.Therefore,surgery was performed to remove the object(fishbone)and drain the abscess.After a 2-wk uneventful recovery,the patient was discharged.The final diagnosis was foreign body-induced hepatic abscess of the caudate lobe.CONCLUSION Differential diagnosis is important for hepatic masses,and systematic examination and physician awareness can aid in diagnosing and curing such rare conditions.

Cap-assisted endoscopy for esophageal foreign bodies:A metaanalysis

BACKGROUND Esophageal foreign bodies are common around the world.Newer approaches,such as cap-assisted endoscopy,have been introduced as an alternative to conventional methods.Therefore,we performed a meta-analysis ono cap-assisted endoscopy versus conventional endoscopy for removal of esophageal foreign bodies.AIM To investigated the effectiveness of cap-assisted endoscopy with conventional endoscopy.METHODS An extensive literature search was performed(December 2021).For esophageal foreign body removal,cap-assisted endoscopy was compared to conventional endoscopy for procedure time,technical success of the procedure,time of foreign body retrieval,en bloc removal,and adverse event rate using odds ratio and mean difference.RESULTS Six studies met the inclusion criteria(n=1305).Higher odds of technical success(P=0.002)and en bloc removal(P<0.01)and lower odds of adverse events(P=0.02)and foreign body removal time(P<0.01)were observed with cap-assisted endoscopy as compared to conventional techniques.CONCLUSION For esophageal foreign bodies,the technique of cap-assisted endoscopy demonstrated increased en bloc removal and technical success with decreased time and adverse events as compared to conventional techniques.

A Pregnant Woman Died of Sudden Cardiac Death:Should Esophageal Foreign Body Be Considered an Inductive Factor?A Case Report and Literature Review

Here,we report a case of acute attack of coronary heart disease(CHD).A 47‑year‑old pregnant woman with gestational hypertension developed sudden‑onset chest tightness,palpitations,dyspnea,and cyanosis of the face and lips after admission.Her blood pressure was 180/110 mmHg and her blood oxygen saturation was 45%at that time.After cardiopulmonary resuscitation,a weak heartbeat was restored,but oxygen saturation did not increase significantly.Therefore,she was transferred to the intensive care unit;however,she died after 21 days of admission.Autopsy findings revealed that a foreign body was embedded in the esophagus near the right piriform,and her heart weighed 392 g;histopathological examination revealed CHD,thrombosis in the lumen of the right coronary artery,cardiomyocyte hypertrophy,vascular hyaline degeneration in arterioles,neutrophils in the bronchiole and alveolar.All the tested samples yielded negative toxicological results.Clinical status and autopsy findings were not compatible with a diagnosis of peripartum cardiomyopathy.The patient’s sudden death was attributed to CHD,and esophageal foreign‑body impaction was considered to be concomitant phenomenon.Our findings might help in increasing the awareness between esophageal foreign‑body impaction and sudden cardiac death and they can also help in clarifying that understanding the primary cause of death is the key to resolving an iatrogenic medical tangle.

Neck and mediastinal hematoma caused by a foreign body in the esophagus with diagnostic difficulties:A case report

BACKGROUND Esophageal foreign body(FB)is a common clinical emergency.Clinically,computed tomography(CT)scans are important in the diagnosis of FBs in the esophagus.Here,we report a case of esophageal perforation and cervical hematoma,caused by a FB,whose uniqueness made rapid diagnosis difficult.CASE SUMMARY A 42-year-old man was transferred to our hospital with esophageal perforation,which was accompanied by cervical and mediastinal hematoma.CT scans only revealed a black shadow,approximately 2.5 cm in diameter,in the upper esophagus.After multidisciplinary discussion,he was quickly subjected to mediastinal hematoma resection,peripheral nerve compression release,esophageal FB removal and esophagectomy.Eventually,we removed a small crab with a pointed tip from his esophagus.CONCLUSION This was an unusual case of occurrence of sharp polygonal esophageal FBs caused by a small crab.Rapid diagnosis of this FB was difficult,mainly due to its translucent nature.Occurrence of sharp FBs,with cavities that sometimes only appear as black shadows on CT scans,can easily be mistaken for esophageal lumens.More attention should be paid to such sharp polygonal FBs.

Novel use of esophageal overtube and water flushes as a safety indicator and facilitator for the push technique in esophageal food impaction

Esophageal food impaction requires urgent endoscopic intervention either by extraction or pushing into the stomach.Due to risks of perforation,controversy exists between when to extract verses when to push the food bolus.There are no clear guidelines on when it is safe to push a food bolus;endoscopists rely on their subjective experiences and judgment.We present a case with a novel use of an esophageal overtube and water flushes to determine the safety of pushing a food bolus and facilitate passage into the stomach.