Hindawi Publishing Corporation

Case Reports in Pulmonology

Volume 2016, Article ID 3403952, 4 pages
http://dx.doi.org/10.1155/2016/3403952

Case Report
Airway Complications from an Esophageal Foreign Body

Ismael Garcia,1 Joseph Varon,2,3,4 and Salim Surani5

1
Facultad de Medicina Tampico, Universidad Autónoma de Tamaulipas, Tampico, TAMPS, Mexico
2
Dorrington Medical Associates, Houston, TX, USA
3
Foundation Surgical Hospital, Houston, TX, USA
4
The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
5
Texas A&M University, Corpus Christi, TX 78413, USA

Correspondence should be addressed to Salim Surani; srsurani@hotmail.com

Received 3 August 2016; Revised 20 September 2016; Accepted 6 November 2016

Academic Editor: Fabio Midulla

Copyright © 2016 Ismael Garcia et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Introduction. Foreign body impaction (FBI) in the esophagus can be a serious condition, which can have a high mortality among
children and adults, if appropriate diagnosis and treatment are not instituted urgently. 80–90% of all foreign bodies trapped in the
esophagus usually pass spontaneously through the digestive tract, without any medical or surgical intervention. 10–20% of them
will need an endoscopic intervention. Case Report. We hereby present a case of a large chicken piece foreign body impaction in the
esophagus in a 25-year-old male with mental retardation. Patient developed hypoxemic respiratory failure requiring intubation.
The removal required endoscopic intervention. Conclusions. Foreign bodies trapped in the upper gastrointestinal tract are a
serious condition that can be fatal if they are not managed correctly. A correct diagnosis and treatment decrease the chances of
complications. Endoscopic treatment remains the gold standard for extracting foreign body impaction.

1. Introduction endoscopy versus rigid endoscopy. The rigid endoscopy is

considered the gold standard for the treatment of FBI [5]. In
A foreign body impaction (FBI) in the esophagus can be a cases when the airway of the patients seems compromised the
serious condition with high mortality rate among children use of a rigid endoscopy and intubation are the best treatment
and adults. A foreign body can be defined as the presence option [6, 7]. The choice by the clinician relies on the patient
of any object, food, or material in the upper gastrointestinal condition, the characteristics of the object, and the location,
tract, swallowed by accident or intentionally [1]. Children type, form, size of material, object or food that got impacted,
are more commonly affected by these conditions than adults. and the anatomical portion of the esophagus which gets
In the adult population, certain special conditions, such as affected, and the duration of FBI episode [8].
mental retardation, psychiatric disorders, alcohol intake, and We hereby present a case of a foreign body in the esopha-
demented or edentulous patients, put them in a higher risk for gus caused by a food bolus impaction with a piece of chicken
developing an FBI [2]. in a 25-year-old male with mental retardation; patient
Studies have shown that 80–90% of all foreign bodies developed hypoxemic complications which were resolved.
trapped in the esophagus pass spontaneously whereas the This was managed endoscopically via using flexible video
remaining 10–20% of cases will require an endoscopic inter- endoscope by Olympus.
vention to remove the FBI [3].
Radiological imaging of the neck and abdomen can allow 2. Case Report
the clinician to identify the radiopaque object and complica-
tions as esophageal perforation [4]. There are various ways 25-year-old gentlemen presented to the emergency depart-
to achieve removal of a FBI; these include nonendoscopic ment (ED) due to acute shortness of breath and bron-
methods and endoscopic methods, which include flexible chospasms after ingesting the chicken piece. Patient past
2 Case Reports in Pulmonology

without difficulty up to the upper esophageal sphincter,

where a very large piece of chicken was identified occluding
the proximal esophagus and causing significant pressure on
the posterior tracheal wall. A tunnel in the middle of the
chicken piece was made and grabbed in pieces with a snare
and eventually removed as much as possible, weakening the
center piece so the rest of the piece could pass easily into the
stomach. The scope was advanced into the duodenum, which
was in the normal limits without any acute findings.
Following the EGD, the patient was able to be successfully
extubated. Patient initially received intravenous antibiotics,
which was switched to oral antibiotics, and was discharged
Figure 1: Computerized tomography of chest demonstrating foreign home on oral antibiotics in 3 days.
body impaction versus mass in esophagus.
3. Discussion
The foreign body impaction (FBI) is considering an emergent
medical history was significant for mental retardation, bipo- situation. FBI is defined as the presence of any object,
lar disorder, seizure disorder, and hypertension. material, or food that gets trapped in the upper gastrointesti-
Patient was eating a chicken piece for meal, according to nal tract, usually swallowed by accident or in some cases,
the witness he started to have a choking episode, Heimlich intentionally. Some data reports that around 100,000 of FBI
maneuver was performed, and a piece of the chicken was occur each year in the United States of America [9]. This
expelled. He started having severe respiratory distress after event can lead to high morbidity and mortality [10]. It is
the incident and was transferred to the ED via ambulance. estimated that between 1,500 and 1,600 patients die yearly due
On arrival in ED, the patient was in significant respiratory to FBI and esophageal perforation being the most dreaded
distress. Patient was placed on oxygen supplementation with complication [11].
nonrebreather mask at 15 L/min. On auscultation stridor was We presented a case of a FBI in a 25-year-old adult.
heard in upper airway and rhonchi were heard in all lung Although children’s are the ones most commonly affected
fields. Patient blood pressure was 162/97 mmhg, heart rate (specially between 6 and 72 months of age), [6, 10–12], our
was 103 beats/min, respiratory rate was 30/min, and pulse patient with history of mental retardation made him a high-
oximetry showed an oxygen saturation of 100%. Patient risk person for FBI. In addition, other factors for adults
temperature was 99.3∘ F. An X-ray with lateral view of the include gastrointestinal alterations [9, 12, 13], psychiatric dis-
neck was performed, showing no radiopaque foreign body orders, alcohol/drug intoxication, being edentulous elderly,
within the pharyngeal or laryngeal region. Cervical spine X- baseline dementia, or altered mental status [8, 11].
ray to the level of C5 was within normal limits. Patient WBC Numerous objects and food can get impacted in the
count was 18.5 mm3 . Electrolytes and electrocardiogram upper gastrointestinal tract [6, 10, 11, 14]. In our case a piece
were within normal limits. Patient underwent an emergent of chicken was swallowed. The literature reveals that in
bronchoscopy in the ED revealing no foreign body and adults FBI with food occurs more frequently, especially meat
normal airway. Patient continued to have respiratory distress products, fish, or chicken bones [15]. Among the pediatric
and bronchospasms, which failed to improve postracemic population, coins and small batteries are the most common
epinephrine and steroid. Patient was intubated with excellent objects [6, 14].
arterial blood gas (ABG) with no significant A-a gradient. Majority of the FBIs do not need any kind of intervention
Patient was also placed on empiric broad-spectrum antibiotic or treatment, data reports that around 80 and 90% of the
with piperacillin and tazobactam. In the following day, FBIs will pass from the esophagus to the stomach without
patient had an excellent oxygenation on arterial blood gas. any intervention, the remaining 10–20% will need endoscopic
Patient was extubated. Immediately after extubation patient intervention, and 1% of the FBIs cases will require surgical
went into severe respiratory distress and bronchospasm, intervention [6, 8, 10, 14, 15]. In our case the need of endo-
requiring immediate reintubation. scopic intervention was needed as it compromised the airway
CT scan of the chest was performed which showed a large by extrinsic pressure on the membranous wall of the trachea,
soft tissue mass 8 × 6 cm posterior to the trachea, extending to leading to the tracheal collapse. The clinical presentation as
the left of midline posterior to the left thyroid lobe (Figure 1). seen in our patient causing airway compromise is seen in
The mass displaces the trachea anteriorly and slightly to the 10% of the cases [16]. In some cases, patients with FBI may
right. Differential diagnosis included esophageal mass versus be asymptomatic, to be diagnosed later on during imaging
large left thyroid versus possible nonopaque foreign body. studies or examination as an incidental finding. In other
Other findings reported were posterior right upper lobe and circumstances, patient presents with array of symptoms (see
bilateral lower lobe consolidations. Table 1) [11, 14, 16].
In the view of the patient history of possible foreign body In most cases making an accurate diagnosis is simple,
ingestion, patient underwent esophagogastroduodenoscopy as patient presents with the history or has been witnessed,
(EGD). The flexible video endoscope was inserted and passed and other times it can be complex, especially in case of very
Case Reports in Pulmonology 3

Table 1: Clinical manifestation of foreign body impaction. 4. Conclusions

System Symptoms Foreign bodies trapped in the upper gastrointestinal tract
(i) Abdominal pain are a serious condition that can be fatal if not managed cor-
(ii) Dysphagia rectly. Accurate diagnosis and urgent treatment decrease the
(iii) Halitosis complications risk. Although majority of these events resolve
(iv) Hematemesis spontaneously by themselves, some do require intervention.
Gastrointestinal
(v) Nausea Endoscopic treatment remains as the standard for extracting
(vi) Odynophagia foreign body impaction. Physicians need to perform adequate
(vii) Regurgitation
history and if unavailable or in doubt imaging studies need to
(viii) Vomiting
be done to identify the FBI and site of impaction.
(i) Cough
(ii) Drooling
Respiratory (iii) Dyspnea Competing Interests
(iv) Stridor
(v) Wheezing The authors declare that there are no competing interests.

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