Alternative salvage technique for removing large sharp foreign body near upper esophageal sphincter

Difficult oesophageal foreign body removal: a novel surgical approach to a complex situation

BACKGROUND

Ingested foreign bodies pose a unique challenge in medical practice, especially when lodged in the oesophagus. While endoscopic retrieval is the standard treatment, certain cases require more innovative approaches.

METHODS

This paper reports the case of a patient who intentionally ingested a butter knife that lodged in the thoracic oesophagus. After multiple endoscopic attempts, a lateral neck oesophagotomy, aided using a Hopkins rod camera and an improvised trochar as a protective port, was performed.

RESULTS

The foreign body was successfully extracted without causing oesophageal perforation. The patient was made nil by mouth, with nasogastric feeding only until a swallow assessment after one week. The patient was discharged and recovered well.

CONCLUSION

This case illustrates a successful, innovative approach to removing a foreign body in a high-risk patient, highlighting the significance of adaptability in surgical practice. It emphasises the need for individualised approaches based on the patient's history, the nature and location of the foreign body, and associated risks.

Cut endotracheal tube for endoscopic removal of an ingested push-through pack

A 52-year-old female presented to our clinic after accidentally ingesting a push-through pack (PTP). After determining that the PTP was present in the stomach, we successfully and safely removed it endoscopically by using a handmade endoscopic hood fashioned from a cut endotracheal tube. Foreign body ingestion is a common clinical problem, and most ingested foreign bodies pass spontaneously. However, the ingestion of sharp objects, such as PTPs, increases the risk of complications, and urgent endoscopy is recommended to remove such objects. Previous studies have reported the use of other devices, both commercial and handmade, for the safe endoscopic removal of foreign bodies. The novel design of our handmade hood for the removal of the PTP, which was fashioned from a cut endotracheal tube, was beneficial in terms of maintaining a wide visual field, patient safety and tolerance, and easy preparation compared to previously reported commercial and handmade devices. It may be a viable and safe device for the retrieval of PTPs and other sharp foreign bodies.