A 21-Year-Old Man With Epigastric Pain After a Wild Party

Abraham A. Ayantunde, MB BS, FRCS; George G. Araklitis, MB BS, BSc

Disclosures

February 25, 2019

Discussion

In this case, the chest and upper abdominal x-rays revealed that the patient had ingested a foreign body, which appeared to be lodged at the gastroesophageal junction. No radiologic or clinical evidence suggested air in the mediastinum or under the diaphragm, which ruled out an upper gastrointestinal perforation.

The patient admitted to uncapping the bottles of alcoholic beverages with his teeth. He had accidently swallowed one such metallic bottle cap that, having impacted at the gastroesophageal junction, was responsible for his symptoms (Figure 2).

Figure 2.

The patient's own inebriation probably caused him to swallow the foreign body and was also the reason why he could not remember swallowing it. The patient denied any recent problems with swallowing solids or liquids, but he had not tried ingesting any solid food since the occurrence of the incident. A common symptom of total luminal obstruction is the inability to swallow one's own secretions. This was not the case here, and presumably some fluids were able to bypass the obstruction.

Gastrointestinal foreign objects are either ingested (intentionally or accidently) or inserted rectally. They are encountered in all age groups but are more commonly seen in children between 6 months and 6 years of age.[1] In adults, they are found more frequently in those with psychiatric or behavioral problems, and, as in this case, in cases of alcohol intoxication.[1] Foreign-body ingestion may also occur accidently in patients who have dental prostheses. In the United States, approximately 1,500-1,600 deaths occur annually due to foreign-body ingestion or insertion.[2]

A wide variety of foreign objects may be found in the gastrointestinal tract; a review of foreign bodies found in the gastrointestinal tract of patients who presented to the emergency department in London showed that the most common objects were coins (18.4%), aerosol caps (rectally; 10.5%), metal blades (10.5%), and AA batteries (7.9%).[2] Disc batteries are especially dangerous if ingested because they can cause caustic injury and quickly result in tissue necrosis and esophageal perforation. Intentional gastrointestinal foreign-body ingestion and insertion are more common than accidental occurrence in the adult population.

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