Esophageal Perforation following Accidental Ingestion of a Razor Blade

The role and value of low-dose computed tomography scan compared to esophagoscopy in the diagnosis of foreign body ingestion in adults

BACKGROUND

Information regarding computed tomography (CT) scan as a first-line screening tool for diagnosis of foreign body (FB) ingestion is limited to a few studies. This study aimed to discuss the role of low-dose CT scan in diagnosing FB ingestion and its complications in adults, along with its diagnostic values compared to X-ray and esophagoscopy.

MATERIALS AND METHODS

In this retrospective, cross-sectional study, all hospital records of adult patients diagnosed with foreign body ingestion from March 2014 to February 2019 were reviewed.

RESULTS

Among a total of 114 patients, 41 (36.0%) and 86 patients (85.1%) had positive findings in favor of FB in chest radiographs and CT scans, respectively. Esophagoscopy showed the presence of a foreign body in a total of 95 (83.3%) cases, perforation in 14 cases (12.3%), and laceration in nine cases (7.9%). Also, 12 patients (10.5%) had no findings in their esophagoscopy. The sensitivity, specificity, positive predictive value, and negative predictive value of chest X-ray were 39.2%, 91.7%, 97.6%, and 15.1%, respectively. The sensitivity and specificity of CT were reported to be 96.62% and 100%, respectively. The positive predictive value of the CT method was 100%, and its negative predictive value was 80.0%.

CONCLUSION

CT scan can be the preliminary tool for the diagnosis of FB ingestion. It can decrease hospital stay and hospital costs by avoiding unnecessary endoscopy. Due to the insufficiency of X-ray, low-dose CT can be used as a first-line diagnostic tool, especially in cases with ingestion of radiolucent FBs.