Marc Ong, MBBS, MRCS, FRCS1, Wei-Wen Ang, MBBS, MRCS1, Vishal G Shelat, MBBS, MRCS, FRCS2. 1Khoo Teck Puat Hospital, 2Tan Tock Seng Hospital
A 55-year-old man presented with acute onset of dysphagia following a meal which consisted of rice and octopus. He reported vomiting immediately after congestion of food/liquid thereafter. No other symptoms or signs were present. Laboratory tests did not reveal any abnormalities. A computed tomography of his neck and thorax was performed which revealed esophageal dilation with an apparent obstruction by a hyperdense mass (Figure A).
An esophagogastroduodenoscopy was promptly performed which showed an octopus lodged at the distal esophagus 5cm from the cardio-esophageal junction (Figure B). Initial attempts at extraction of the food bolus proximally were unsuccessful as it was firmly impacted. Subsequently a gentle pressure with the tip of the endoscope was applied directly on the food bolus but to no avail. Finally, the scope was maneuvered carefully past the food bolus into the stomach, retroflexed and a toothed retrieval forceps was used to grasp the distal edge of the octopus head. The food bolus was then gently pulled into the stomach (Figure C). The patient was discharged well from the hospital 2 days later.
Foreign body ingestion and food bolus impaction are frequent problems encountered in endoscopic practice with majority occurring in the pediatric population. 80-90% of ingested foreign body/food bolus will pass spontaneously, while the remaining 10-20% of cases will require endoscopic management and less than 1% require surgery. There seems to be an association with dietary habits of different regions with food boluses encountered. In the United Stated, beef particularly and chicken are most common causes of food impaction, whereas in Asia and coastal countries, fish is most common. The “push technique” is the primary method recommended with high success rates, however applying excessive force can cause esophageal perforation. Failing which, retrieval either en bloc or piecemeal may be attempted using a variety of instruments including grasping forceps, snares, retrieval nets or endo baskets. Airway protection is pivotal if the latter method is adopted, necessitating endotracheal intubation or the use of overtubes for protection of the esophageal/pharyngeal mucosa from trauma especially during the retrieval of sharp objects.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 92783
Program Number: P423
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster