A 38-year-old female presented to an emergency department af | Figure 1
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A 38-year-old female presented to an emergency department after feeling a sharp, painful sensation in her throat following ingestion of a lamb casserole. The pain was worse on swallowing and radiated to the right chest and between her shoulder blades. Examination was unremarkable, the patient’s voice remained unchanged, and there was no abnormality on fiberoptic nasendoscopy.
A diagnosis of an ingested foreign body was proposed. A chest and lateral neck x-ray showed no evidence of a foreign body but a CT showed a bony foreign body within the thoracic oesophagus at the level of the azygos vein located 2 mm from the aortic arch. It measured 20×21 mm and was stretching the lumen of the oesophagus but there was no evidence of perforation or vascular injury.
A rigid oesophagoscopy was performed under general anaesthesia with support from on-site cardiothoracic surgeons and a cardiac anaesthetist given the possibility of severe haemorrhage. A 40-cm rigid oesophagoscope was passed into the upper oesophagus atraumatically where the bone was visualised at 22 cm from the upper incisors. No recent or active bleeding was seen. Grasping forceps were used under direct vision and the bone was gently dislodged from the wall of the oesophagus and removed in its entirety without excessive traction required. A small mucosal tear on removal of the bone occurred with a small amount of blood.
Read the outcome and discussion in the full case report
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