Journal Article

1900 Crushing the Star: Esophageal Foreign Body Extraction Using Dormia Basket

Qayed, Emad, Kilakkathi, Sindhu, Mulki, Ramzi, Shah, Rushikesh

2019

Overview

INTRODUCTION:Sharp objects impacted in the esophagus require prompt endoscopic removal. Removal of sharp foreign bodies can be technically challenging and care should be taken to avoid inducing esophageal trauma during retrieval.CASE DESCRIPTION/METHODS:A 69-year-old female presented with sudden onset dysphagia and sharp chest pain for 1 day. While eating cake one day prior to arrival, she reported sudden, sharp, central chest pain followed by a sensation of food being stuck in her esophagus. Her physical examination was unremarkable with no abdominal tenderness. Her laboratory tests revealed normal complete blood count and chemistry. Chest x-ray revealed no acute abnormality. Upper endoscopy showed a sharp star-shaped foreign body (FB) approximately 2 cm in diameter (Figure 1). The FB was lodged in the distal esophagus, causing mucosal trauma. Due to the large size of the FB, insertion of an overtube was not considered to facilitate removal. An attempt was first made to extract the FB with rat-tooth forceps, but it could not be retrieved through the upper esophageal sphincter. Mucosal trauma was seen in the mid and proximal esophagus following this attempt. The FB was then advanced to the gastric antrum using a Roth net. Attempts to break the FB using argon plasma coagulation (APC) and a snare were unsuccessful due to the rigid nature of the FB. Subsequently, a 2T dual channel therapeutic gastroscope was inserted, and a Dormia stone retrieval basket was used to grasp the foreign body. Using the crushing power of the basket, the FB was successfully crushed and pulled inside the large therapeutic channel of the scope. The scope was withdrawn without additional mucosal trauma. The FB consisted of a star-shaped cake decoration with sharp edges (Figure 2). Following the procedure, the patient reported immediate improvement in her chest pain.DISCUSSION:This is a unique case wherein after the failure of conventional foreign body extraction devices, a Dormia stone retrieval basket was used to crush the object within the stomach allowing for safe retrieval. Gastroenterologists should consider this approach when retrieving irregularly-shaped, sharp, but pliable FBs. For the general public, care should be taken when eating food with non-edible decorations and toppers to avoid inadvertently swallowing or aspirating these objects.

• Publisher: Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
• Subject: Esophagus / Foreign bodies